Prior Authorization Portal
Enables providers to electronically submit prior authorization requests and view all requests and their statuses
Expansion of provider access to our Authorization Portal in the Individual and Family Plan markets of Texas, Georgia, Utah, California, and Virginia, and Medicare Advantage markets outside California.
Access to our Authorization Portal enables our providers to enter and monitor the status of their authorizations electronically – and our internal operations are more efficient with upfront validation, well-structured data, and greatly reduced back-and-forth interactions. After just a few weeks in these newly enabled markets, we are already seeing more than 15% of authorizations being submitted electronically (and growing) and clinical intake times reduced by 50%. Providers continue to tell us they love the tool – some have said it is the best one they have used. It all adds up to a more optimal experience that benefits the provider, the member, and Bright HealthCare.
Previously, providers (Individual and Family Plan markets of Texas, Georgia, Utah, California, and Virginia, and Medicare Advantage markets outside California) have only been able to submit authorizations by fax, which is not ideal for anyone. When faxing, providers lack access to important data and real-time validation, to ensure their request is accurate and complete. Converting faxes into actionable digital data is also time consuming and leaves us open to error in our internal operations. The end result can be frustration for providers, members, and Bright HealthCare.
Prior Authorization Fax Form providers had to use before building the Portal that allowed them to send electronically.
Portal Auth Stats
Scaled from 100 monthly users —> 9-10K a month $1.9 mil in savings
Saving 7 min per case; $800K savings for clinicians reviewing cases (as of Sept) 22K providers logged in /50K authorizations through the portal ; 10K auths just from Evolent /200 releases to prod
Time spent per authorization down 4 minutes; saving each provider an average of 4 hours per day during the authorization process
Medical practices complete an average of 40 prior authorizations per physician, per week - 10 min+ per auth
We have had 16.6k unique visitors log in since go-live (across those users they have logged in 100k times)
The dashboard has been visited 304.7k times
Latest intake number
Saved 2,638 hours as of 7/8 by bypassing Intake validation for portal cases (7 min per case x ~22K cases since 2/25, that is 1.25 resources full time for a year
Total Forecasted Savings for 2022: $2.5M
Example of how we reduced Intake costs:
Saved 728 hours bypassing Intake validation (7 min per case x 6247 cases since 2/25).
Avg case wait time is now 1-2 hours shorter!
Most routine tasks 2-3X faster in time studies
Prior Authorization Prototype