Availity, the nation’s largest real-time health information network, and Regence, a family of regional health plans serving members in Oregon, Washington, Idaho and Utah, announced today the results of their collaboration to improve the pre-authorization process through the implementation of new tools that allow for real-time, electronic and automated pre-authorization.
To download a copy of “Adhering to Cost-Effective, Evidence-Based Care Through Improvements to the Pre-Authorization Process,” click here.
The pre-authorization process helps determine coverage of prescribed services or treatments, providing additional oversight to uphold safety, efficacy, quality, and cost-efficiency of care. However, it can be a source of frustration for providers when it causes unnecessary delays of treatment for patients.
Regence and Availity embarked on a pilot program to redesign and improve this process to increase efficiency and reduce providers’ administrative burden. The focus was automating key components throughout the entire pre-authorization process.
Results from the 15-month pilot showed:
- On average, 58% of electronic pre-authorization requests were unnecessary, adding delays and potential adverse health impacts to the care process
- Auto approvals were up to six days faster compared to pre-authorizations initiated by phone, fax, or email
- Relative time savings of 6,190 days, or approximately 17 years, for members and providers due to faster approvals
“The conventional prior authorization process is akin to using a VCR in 2020: it’s outdated, time-consuming and overly burdensome,” said Cheryl Pegus, MD, MPH, President of Consumer Health Solutions, Regence. “Our pilot program with Availity shows how implementing modern tools such as electronic pre-authorization and automated pre-authorization can be a leap forward, enhancing convenience and speed for all involved.”
“While the pre-authorization process can yield cost savings, it is also difficult to manage, which creates avoidable expenses and administrative burdens,” said Sean Kilpatrick, Senior Director of Product Management, Availity. “We are pleased to collaborate with Regence on this initiative, which confirmed that the integration of Availity systems in both the provider and the payer side of healthcare transactions allows for pre-authorization process automation that benefits providers, patients, and payers.”
Regence serves approximately 3.1 million members through its Regence health plans in Idaho, Oregon, Utah and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.
Availity is the place where healthcare finds the answers needed to shift focus back to patient care. We work to solve communication challenges in healthcare by creating a richer, more transparent exchange of information among health plans, providers, and technology partners. As the nation’s largest health information network, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.