Prior authorization in healthcare requires providers to obtain approval from insurance payers before seeing the patient. While this process is intended to manage costs and ensure medical necessity, it often leads to significant delays in patient care. The traditional manual process is time consuming, often involving verification of patient insurance details, submission of requests, and follow-ups with insurers. This then entails lengthy phone calls and navigating complex online portals, with each request taking an estimated 15-20 minutes. If a request is denied, providers must prepare additional documentation or appeal letters, further complicating the process.
In contrast, automated prior authorization systems significantly enhance efficiency. These solutions can quickly retrieve essential patient data, validate information, and prepare requests in a fraction of the time. They also automatically update medical records and track the status of requests.
The complexities of the current system have serious implications. Rising operational costs have led 35% of providers to hire additional staff for managing prior authorizations, which can cost around $11 per authorization. Nearly 93% of physicians report high administrative burdens, and delays can increase time to access care by 100%, with serious risks to patient health.
In this challenging environment, Orbit offers a transformative solution. Its AI-powered prior authorization automation system has saved providers approximately 60% on costs and generated $449 million in savings across the U.S. healthcare industry. By streamlining workflows, Orbit reduces turnaround times by 55%, allowing staff to reclaim nearly 12 hours per week and ultimately ensuring more efficient, patient-centered care.
Source: Orbit Healthcare