SSI Prior Authorization
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Enterprise-wide end-to-end prior authorization that includes infusion, physical, occupational, and speech therapies (anything covered under medical benefits)

Reduce the time it takes to complete existing workflows by 90%

According to a recent Medical Group Management Association poll, prior authorization (PA) is the most time-consuming of all revenue cycle transactions, taking your staff between 20 to 60+ minutes for each one. Of all 2021 CAQH Index-tracked administrative transactions, PA is the highest-cost transaction across the medical industry. It is also one of the leading causes of claim denials, with a recent report by the American Hospital Association (AHA) showing hospitals and health systems are experiencing a growing volume of claim denials, driven in large part by prior authorization issues.

The SSI Prior Authorization solution can reduce denials and end the time-consuming detective work necessary for PAs by automating the process from end to end.

real-time payer connections

%

of covered US patients

%

reduction in authorization cycle time

%

less claims rework

Solution Highlights

  • Hospital enterprise-wide solution including infusion, physical, occupational and speech therapies—anything included under medical benefits
  • 700+ real-time payer connections
  • Reduces the complexity, costs, and time crunch of a manual process
  • End-to-end automation that takes seconds to complete

How It Works

STEP 1: Determines if PA is required and sources appropriate submission form
SSI Prior Authorization powered by Myndshft includes a proprietary Payer Rules Engine and Policy Library that identifies PA requirements based on the payer, plan, and CPT or HCPCS codes provided.

  • Connects in real-time to 700+ payers covering 94% of covered US patients
  • Synchronizes eligibility and PA rules for continuously up-to-date information
  • Uses patients’ payer, plan, service type, place of service, diagnosis and clinical data to improve the accuracy of PA determinations
STEP 2: Pre-screens PA submissions for errors and medical necessity
SSI Prior Authorization selects the appropriate payer submission form and pipes in relevant data including clinical encounter details directly from your system of record using industry-standard HL7 FHIR APIs.

  • Automatically checks the request for errors and missing information
  • Supports PDF uploads of signed physician orders, medical history, and other documentation
  • Eliminates double entry, reducing the likelihood of human error and preventable denials
STEP 3: Submits PA request directly to the payer
After providing the required data, SSI Prior Authorization submits the request with attachments to the payer.

  • Uses each payer’s preferred submission method, i.e., fax, payer portal, or EDI 278 transaction
  • Generates a time-stamped submission ID for easy status tracking
STEP 4: Monitors PA request statuses
All submitted PA requests can be monitored in one convenient location, with PA approvals returned directly to your system of record.

Features & Benefits:

Real-Time Benefits Verification

  • Instantly pinpoints medical benefits, coinsurance, copay, deductible, and other plan details for 94% of U.S. covered patients
  • Verifies plan and group-specific PA requirements instantly
  • Organizes primary, secondary, or tertiary payers according to payment responsibility, even if not provided by the patient
  • Ensures the correct payer has been identified before checking prior authorization requirements

Hands-Free Prior Authorizations

  • Pre-checks for errors, missing information, and medical necessity
  • Submits PA request via each payer’s preferred submission path
  • Monitors status of all PA requests in one convenient location
  • Boosts productivity by automating repetitive, error-prone manual tasks
  • Reduces expenses by preventing avoidable denials and operational inefficiencies

Enhance Patient Experience

  • Significantly decreases patient’s time to care
  • Reduces the need to reschedule or delay patient treatments
  • Frees staff to increase capacity or reallocate to more patient-centric, high-value tasks

Request A Demo

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