The gamesmanship of ​getting prior authorization approval on a surgery

This chart is a typical journey on what it takes to get prior authorization approval before a surgery. Anyone with common sense can detect there is a lot of inefficiency and frustration going on in this 11 step process.

According to University of Wisconsin Hospitals and Clinics, there were a $18.2M negative impact on their revenue in 2019 in managing prior authorization, and $3.6M revenue loss due to cancellation and rescheduling because of prior authorization delay.

Physicians typically end up with the responsibility to interpret the prior authorization policy. The real game changer here is to have AI comb through prior authorization policies. Use encounter note and test note to trigger right prior authorization forms and automate the language for the forms. It can drastically reduce surgery delay and abandonment.