Paying the Price When Provider Data is Unclear
In 2018, 57% of Americans experienced a surprise medical bill — that is, an invoice for services they thought were covered by insurance¹. Of that group, 20% reported that these unexpected bills were the result of visiting a doctor who was not part of their insurance network.
To find an in-network practitioner, and his or her office location, hours and contact information, many consumers rely on their health plan’s provider directory. …
Streamlining this process will save time, money and improve patient access to care.
Prior authorization is intended to help manage the use of healthcare resources, reduce overuse or misuse of services and control healthcare spending.
At a high level, the process is seemingly straight-forward: a healthcare provider will submit their intended treatment plan to the patient’s insurance, the plan will review the request, ask for follow-up information if necessary and issue a decision as to whether or not it is authorized.
A standard electronic method for conducting at least a portion of the prior authorization process has been federally mandated since the early 2000s. However, nearly 20 years later, 88% of prior authorizations are still conducted either partially or entirely manually,¹ using faxes and phone calls to request and provide clinical information. …
There is a lot of buzz around artificial intelligence (AI) right now.
Millions of people rely on AI-powered voice assistants like Alexa and Siri as a normal part of life. Everyone is familiar with Netflix and other streaming video services suggesting what to watch next. Google auto-filling online forms is a great time-saver, albeit a nuisance at times. AI is no longer science fiction — it’s mainstream.
Just about every industry has been employing AI technology to create efficiencies and improve quality for decades. …