How AI Technology Reduces Prior Authorization Processing Time by 30.27%

Whether we knew it or not, we’ve all experienced prior authorization in some way. Prior authorization is a complex process where healthcare payers determine whether a prescription, procedure, or referral is clinically appropriate, and that impacts whether you receive the treatment or not.

But as widespread as prior authorization is in the lives of providers, patients, and payers, the current method for facilitating this process is error-prone, tedious, and costly. In a real-world sense, this manual process can delay treatments or prevent care altogether, and the consequences can range from inconvenient to life-threatening.

How AI Technology Reduces Prior Authorization Processing Time by 30.27%

How AI Can Ease the Prior Authorization Process in Healthcare

Fortunately, Hindsait’s AI-powered technology is addressing this problem directly. It can optimize prior authorization decisions as well as the audit process, which brings savings and makes it faster, more accurate, and less burdensome for both healthcare providers and patients.

Here are some of the remarkable results Hindsait can deliver:

• 30% reduction in processing time for prior authorizations
• 35% reduction in appeals and reconsideration decisions
• Millions saved in unnecessary or overpayments
• Faster decisions: from days to minutes

AI-Empowered Prior Authorization in the Real World

In late 2022, the federal government requested its partners to enhance the efficiency of medical documentation review by using more technology in the process. WPS Health Solutions, one of our customers, decided to meet this challenge by using Hindsait.

They ended up coming up with 18 use cases and successfully integrating them into production which showed a 30.27% reduction in processing time for prior authorizations. This huge efficiency gain also ensured consistency and accuracy across the board, allowing them to process nearly 170,000 documents annually. You can read WPS’s full story here.

Now that we understand the benefits this technology can offer to help payers streamline their prior authorization process, let’s dive into the how.

How Prior Authorization with Hindsait Works

1. Data Ingestion and Processing Medical records and unstructured data are ingested through API from your workflow platform, such as OnBase. Hindsait processes this data in real-time, ensuring that only clean, high-quality data enters the pipeline. This minimizes the risk of downstream issues and sets the stage for accurate decision-making.
2. Automation and Data Extraction Hindsait uses Robotic Process Automation (RPA) to extract relevant data from various document formats. This includes Optical Character Recognition (OCR), Computer Vision, Optical Mark Recognition (OMR), and Hindsait’s signature and date detection. Clinical natural language processing then converts the unstructured data into structured formats for analysis. Hindsait’s adaptive algorithms further enhance accuracy by optimizing extraction tools based on document type and historical performance.
3. AI-Driven Decision Engine Hindsait’s AI-driven decision engine evaluates medical records against clinical guidelines and identify cases that meet payer criteria. The AI assigns confidence scores based on machine learning. If the AI determines that a decision is clear-cut, it assigns a higher confidence score. When the confidence score exceeds dynamic, data-driven thresholds, decisions are made automatically without human intervention.
4. Human-AI Collaboration When the confidence score falls below the threshold, healthcare employees collaborate with Hindsait via the AI platform. This collaboration allows employees to focus their time and attention on the most critical cases, rather than spreading their efforts thin across all cases. This accelerates the decision-making process and ensures high-quality outcomes.
5. Continuous Learning and Feedback Hindsait continuously learns from human intervention and feedback, refining its model in real-time. It stores all final decisions and data in a centralized repository, allowing for seamless collaboration and future audit trails. This continuous learning process ensures that the technology remains up-to-date and improves over time.

Revolutionize Your Prior Authorization Process Now

Payers everywhere have grappled with the inefficiencies and losses that manual prior authorization can bring for too long. By reducing processing times, minimizing errors, and saving costs, Hindsait enables healthcare providers to focus on what truly matters: delivering high-quality care to their patients.

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