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Revenue Cycle Prior Authorization

Software that facilitates the electronic transmission of information between provider and payer organizations for (1) determination, (2) submission, and (3) status of authorization of care.

Subject Expert
Dustin Cragun
VP of Revenue Cycle Research
KLAS VP of Revenue Cycle Research - Dustin Cragun
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Decision Insights

Latest Related Report

Automated Prior Authorization 2023: What Impact Do Automated Prior Authorization Solutions Provide?) Report Cover Image
Performance
KLAS article icon
Automated Prior Authorization 2023: What Impact Do Automated Prior Authorization Solutions Provide?
24 January 23
Prior authorization is mandated by payers to ensure that certain clinical procedures and medications being ordered are necessary. To alleviate the heavy administrative burden this requirement causes, healthcare organizations have adopted automated prior authorization solutions. For this report, KLAS interviewed 30 respondents from 26 unique organizations to understand their experiences using these solutions and what outcomes they have seen.

Report Abstract

Key Findings:

  1. Automated Prior Authorization Improves Financial Performance and Staff Efficiency
  2. Expansive Use of Automated Prior Authorization Leads to Higher Satisfaction
  3. Customers Want Further Streamlined Workflows, Are Hopeful for Future Improvement
  4. Some Friction between Prior Authorization Vendors & Payers; Most Provider Organizations See No Change in Their Payer Relationships from Prior Authorization Solutions
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Performance Data

Overall Score by Product

Example Revenue Cycle Prior Authorization overall score by product image

Products Appearing in Decisions

Example Revenue Cycle Prior Authorization products appearing in decisions image

Overall Score by Question Topic

Example Revenue Cycle Prior Authorization overall score by question topic image

Provider Facility Size by Product

Example Revenue Cycle Prior Authorization provider facility size by product image

Provider Facility Type by Product

Example Revenue Cycle Prior Authorization provider facility type by product image



Reducing Filters

Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.

This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.

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