Prior Authorization
Providing patients with electronic updates and physicians with streamlined electronic responses to prior authorization requests.
Expedite Your Prior Authorizations
Lean how both providers and patients can get fast, potentially life saving payer responses for procedures that require prior approval.
Problem
Varying and ambiguous state and federal rules leave patients in the dark and providers forced to delay necessary treatment.
No Insight — Patients have no insight or knowledge about approval or denial.
Up in the Air — It takes days, weeks, or longer to receive a decision.
Delays — Dangerous treatment delays for acute, chronic and complex conditions.
Financial and Administrative Burden — Costly provider and payer misalignment.
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Solution
Da Vinci Payer Data Exchange (PDex) Prior Authorization Profile — Enables payers to communicate prior authorization decisions and any changes directly to patients.
Explanation Of Benefit Resource — is used by PDex to express claims information to members with the CARIN Blue Button® FHIR® Implementation guide (CARIN BB IG).
CARIN Blue Button® IG — Can be customized to include or exclude prior authorization records:
— Pending and active decisions
— Related clinical documentation
— Forms for items and services (not including prescription drugs)
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Benefits
Fast Answers — Receive an answer no later than one (1) business day after a provider initiates prior authorization for the enrollee.
Clarity — Clear understanding of pending versus active decisions and related clinical documentation or forms (not including prescription drugs).
— List of approved units and services
— Approval and ending date record
— Changes of status
No Care Delays — Patients receive the right care at the right time.
ReducedAdministrative Burden — Healthcare providers greatly reduce operational and financial burden with quicker and automated process.