Efforts to transform prior authorization are at a critical crossroads: Will regulatory mandates result in just compliance or catalyze national migration to FHIR-based electronic prior authorization? The answer to this question cannot be found in the specifics of CMS-0057-F but instead resides in the level of trust between health plans and their network providers. There is a compelling ROI for plans, but only if providers jettison ingrained workflows and embrace this new approach.
In this on-demand webinar, Steven Berkow of InterSystems and Robert Tennant of WEDI share findings from approximately 150 payer, provider, policy, and technology stakeholders on the capabilities needed to drive widespread provider adoption.
Watch the webinar to learn:
- Why health plans should look beyond regulatory compliance
- How EHR integration can improve provider adoption
- What providers expect from response speed, reliability, and consistency
- How to prioritize lines of business and covered services
- Why a soft launch can reduce implementation risk
Key Findings for Health Plans
Provider adoption depends on whether electronic prior authorization makes existing processes easier and more reliable. The stakeholder findings suggest that health plans should:
- Offer consistent workflows across major lines of business
- Help providers retrieve and populate required clinical information
- Deliver usable and consistent responses at least 90% of the time
- Make electronic prior authorization accessible through EHR workflows
- Test the experience with selected providers before broader deployment
Speakers
- Steven Berkow, Head of Value-Based Care Market Strategy, InterSystems
- Robert Tennant, Executive Director, WEDI