Evaluation of the Fast Prior Authorization Technology Highway

Area of Science:

• Health Informatics
• Healthcare Management
• Health Services Research

Background:

• Prior authorization (PA) is a payer-driven process requiring provider documentation before payment.
• Manual PA submission is hypothesized to be less efficient than electronic methods.

Purpose of the Study:

• To assess the impact of electronic prior authorization (ePA) on approval rates and decision times.
• To evaluate healthcare provider perceptions of ePA utilization.

Main Methods:

• Analysis of over 40,000 PA transactions before and after ePA implementation.
• Provider surveys conducted by an independent research organization (RTI).
• Evaluation of processing times and provider experiences with ePA.

Main Results:

• Median time from PA request to decision decreased from 18.7 hours to 5.7 hours.
• Approximately 62% of PAs utilized ePA within 6 months of implementation.
• Providers reported benefits in reduced phone calls and faxes with ePA.

Conclusions:

• The primary advantage of ePA implementation is a significant reduction in decision-making time.
• Greater adoption of ePA is recommended, as 38% of PAs remained manual post-implementation.