Problem:

• The primary authorization process was traditionally reliant on manual, paper-based workflows, leading to inefficiencies, errors, and delays in approvals.
• Prior authorization requirements and processes can vary significantly across different healthcare organizations, payers, and regions, leading to confusion and inconsistency in the approval process.
• Lengthy approval times and administrative delays in the prior authorization process can result in delayed access to necessary medications, treatments, or services, impacting patient care and outcomes.

Solution:

• PAS application enables the provider to submit the prior authorization request to payers during the treatment of any patient to check if the treatment is expected to be covered or paid for by the payer.
• The application uses SMART on FHIR protocols before exchanging data between the provider and payer systems.
• The response received from payer systems will be displayed on the user interface of the provider EHR systems without leaving their existing workflow.

Tech Stack:

• Java
• Angular
• SMART on FHIR Authorization Protocols

Benefits:

• Implementing standardized prior authorization processes and interoperable data exchange protocols can streamline administrative workflows, reducing the time and resources required for manual processing and approval.
• Quicker approvals and streamlined processes can lead to improved patient care outcomes, ensuring that patients receive timely access to the treatments and services they need without unnecessary delays or interruptions.
• Stakeholders can experience cost savings and operational efficiencies within their healthcare organizations.