SSI Prior Authorization

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

Solution Highlights

700+ real-time payer/plan connections

Covers anything under medical benefits

(Infusion, physical, occupational and speech therapies)

Reduce prior authorization denials and get ahead of CMS regulations

Prior authorization continues to be one of the most burdensome administrative tasks for providers. 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.

With upcoming CMS regulations requiring an electronic solution by 2026 for incentive payments, now is the time to get ahead by implementing the right automated prior authorization solution.

SSI Prior Authorization can put you on the right path, reducing denials and ending the time-consuming detective work necessary. It can also help reduce the time required to complete existing PA workflows by up to 90%!

Prior Authorization demo screenshot

Watch this brief demo to learn about SSI Prior Authorization – our end-to-end automated prior authorization (PA) solution for hospitals and health systems that provides enterprise–wide improvements.

Have 5 minutes? Watch the demo to see what SSI Prior Auth can do.

Reduce the complexity and costs of your prior authorization process with SSI Prior Authorization.

real-time payer connections

%

of covered US patients

%

less claims rework

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/plans 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:

Hands-Free Prior Authorizations

  • Pre-checks for errors and missing information
  • 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 Prior Authorization Demo

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