Prior Authorization (PA) and Utilization Management (UM) practices are key drivers of member retention and satisfaction, and are a significant opportunity to differentiate your plan in the market. As you know, complex medical necessity reviews can be time consuming and an expensive process for your nurses and physicians.
At PINC AI™ Stanson, we are focused on tackling the hardest part—the complex medical necessity reviews. We can help adopt a clinically-focused artificial intelligence (AI) solution in a way that dramatically improves your UM processes and automates your Prior Authorization, all while gaining the trust of your clinicians and utilization management team.
It’s time to demand instant approval and proof of every decision. Plus, get your members to care faster. Ask us how.
Successful automation can help enhance patient outcomes, reduce physician burden and promote cost improvement.
Estimated up to $26 per initial case reviewer. 1
In 2017, administrative costs totaled $274.5 billion, representing 9.6 percent of total expenditures by insurers and other third-party payers. 2
And eliminate the administrative waste.
1Glassdoor • RN Clinical Reviewer Salary. Available at: https://www.glassdoor.com/Salaries/rn-clinical-reviewer-salary-SRCH_KO0,20.htm Accessed August 2020
Top payers have trusted Stanson to help increase utilization management throughput and lower overall expenses by automating medical necessity determination using AI, natural language processing (NLP) and machine learning (ML) to minimize the need for human review on basic submission and only allocating human review for the most complex cases.
Help reduce administrative expenses and your PMPM.
Use AI, NLP and ML for fact extraction and rule-based adjudication that can be approved with provenance or proof of why the AI approved the request.
Validate a patient’s eligibility and clinical necessity instantly without delaying care.
The AI will show its work or provide proof and a transparent decision trail for auditing purposes that is both clinically and legally defensible.
How Long Prior Authorization Timelines Impact Payer CFOs
The harm to patients from long prior authorization wait times is well documented, but patients are not the only ones who would benefit from shortening the time for prior authorizations.
E-book: Automated Electronic Prior Authorization for Patients, Providers and Payers
The on-demand generation can have an instant prior authorization process that rivals the ease of use of their rideshare, food ordering and movie streaming apps that makes their lives more enjoyable and productive.
Improve Member Experience and Retention
Automated Medical Necessity Reviews
Guidance at the Point of Approval