In an ideal scenario, patients “never know the prior authorization team exists,” Carson Buskard, director, prior authorization, says.
“They get scheduled, show up and receive their test,” Carson said. “Unfortunately, when authorizations are not able to be secured in time, care gets canceled.”
Obtaining prior authorization — the decision made by health insurers that a health care service, treatment plan, prescription drug or medical equipment is medically necessary — can be an arduous task.
After a Corewell Health provider writes an order, it heads to our prior authorization team, who then submit a request to a third-party administrator. This manual process has traditionally required our prior authorization representatives to cull similar identifying data within Epic from each request.
Seeking to free his team of the busywork associated with these referrals and to prevent more canceled care, Carson began researching automation solutions. In 2021, the team partnered with health care payment software maker Waystar, who installed its Real Time Authorization tool: a series of bots that automatically extract certain information from referrals — such as name, date of birth, diagnosis and test being ordered — and submit it directly to third-party administrators.
“These bots allow us to start the process of submitting the authorization, sooner,” Carson said. “By taking out human variables that can sometimes cause issues — and having our team be there to answer the things that can't be answered by discrete data — we're able to support more patients.”
The results? Process time for certain orders has been cut in half and, when paired with preexisting tools within Epic, 78.4% of Carson’s team’s authorizations are now obtained automatically without human intervention.
Corewell Health West and South teams currently use the Real Time Authorization tool, primarily for high-tech imaging and surgery. But Carson anticipates their availability will soon be expanded statewide, thanks to the One Epic Ecosystem program.
“We’re proud to be a leader in the early adoption of so many automation efforts,” Carson said. “The future is bright, and we remain committed to innovation that allows us to better serve our communities.”
Saved Time Saves Lives: More Automation Updates from Across the System
During a rapid improvement event to resolve the lab intake and denial process, 30,000 Corewell Health East accounts needed to be reviewed to determine if charges denied by Blue Cross Blue Shield were payable, leading the Revenue Cycle team to ask, “Can we automate this?”
Key takeaways:
Estimated time for team members to review relevant accounts: 1,250 hours. Time for bot to do the same work: 250 hours. An 80% difference!
Estimated redirected labor savings: $180,000
Priority Health’s contact center recently launched Roman Formum, a bot that sends blank forms to health plan members. It starts with the standard Health Insurance Portability and Accountability Act, or HIPAA, form, which accounts for 32% of forms sent to members. Roman then standardizes documentation by creating, finalizing and saving member request inquiries, which allows for less pivoting between systems, less time searching for content to create letters and elimination of follow-up communications.
Earlier this month, Corewell Health began automating new hires’ enrollment into required role-based Epic Education, and Epic security assignment upon education completion. The Integration Management Office details the standardization process and changes regions can expect.