Patients getting the timely care they need falls directly on how effectively prior authorization is completed. Prior authorization is essentially a request by healthcare providers to insurance companies about carrying out necessary medical procedures or checkups. While this step is necessary, the timeliness of these requests are often a burden to both providers and patients.
Prior authorization in healthcare has traditionally involved labor-intensive manual processes, requiring providers to verify patient insurance and medical histories, submit requests, and follow up—often taking 15 to 20 minutes per request. Denied authorizations complicate matters further, necessitating additional documentation and appeals, which can lead to significant delays in treatment. This inefficiency can cost around $11 per authorization, pushing many organizations to hire dedicated staff, thus increasing operational costs. Unfortunately, nearly 27% of physicians report frequent denials, and 35% say that the criteria for authorizations are often not evidence-based, with denial rates rising over recent years.
Innovative solutions like Orbit are addressing these challenges. Orbit's AI-powered prior authorization process automation drastically streamlines the prior authorization process, saving providers approximately 60% in costs—around $449 million across the U.S. healthcare system. It can handle patient information and scheduling in as little as five minutes, compared to the hours spent on manual methods. This automation not only speeds up authorizations, leading to quicker access to care and better health outcomes, but also reduces human error, improving reliability. On average, automation saves $9.60 per authorization and enhances turnaround times by 55%. By reclaiming nearly 12 hours per week previously spent on manual authorizations, staff can refocus on patient care. Ultimately, adopting technologies like Orbit can transform a cumbersome system into an efficient one, enhancing access to care and improving patient outcomes.