3 steps to employ software innovation in your prior authorization workflows
There’s no better way to set your organization up for prior authorization success than with advanced automation and AI-powered software. An in-depth report on denials by Waystar and HFMA found that 39.7% of denials occur during prior authorization processes, making it vital to use modern solutions to stay on top of volume and slash write-offs without adding staff.
Whether you’ve been using advanced automation software for years or you’re still in the research stages, there are steps you can take to ensure your staff is empowered and your workflows are operating as seamlessly as possible.
- Establish the facts: automated prior authorization works
Once you select the automated prior authorization software your organization will use, show staff its potential. That means features and functionality, of course, but also the results that teams get using this solution.
For example, healthcare organizations that leverage Waystar’s Authorization solutions experience:
- 70% reduction in authorization process time at Primsa Health at 2 minutes per authorization
- 85% auto approval rate without submitting clinical documentation at Primsa Health
- 80% actionable productive responses for in2itive Business Solutions
No matter your solution, sharing success stories with staff is a good way to foster trust and excitement. You’ve chosen a solution because it can address a critical problem or opportunity. Sharing key information with your team sets the stage for success.
- Activate exception-based workflows
Working accounts by exception is one of the most crucial aspects of automated prior authorization.
By automating repetitive, time-consuming tasks, staff can work only the records that truly need intervention. That allows them to:
- Save time
- Focus on high priority tasks
- Improve turnaround times and lead days
- Boost patient and provider satisfaction
- Improve outcomes
If you’re still transitioning to exception-based workflows, increase efficiency by taking four steps:
- Prioritize worklists in your EHR
Set up worklists within your EHR to foster an efficient workflow. Make sure staff can easily identify the records that require attention and sort lists so priority items populate at the top. - Create custom worklist columns
If your EHR allows, add columns to help drive the workflow for staff. For example, add columns to denote authorization status or insurance verification. - Eliminate duplicate or unnecessary tasks
Every extra step you can delete from your workflow will increase efficiency and productivity. That will have a direct impact on other important metrics, such as turnaround times and authorization lead days. - Streamline notations
In healthcare, staff often must notate the same information in multiple areas. Leverage smart phrases, automatic filing, or templates to save time and standardize processes.
- Get staff excited about adopting new technology
When it comes to implementing new technology, organizations that prioritize change management have a drastically better experience than those who assume staff will adopt the technology because they’ll inherently see the benefit.
Communicate clear plans with staff, offer frequent training, and be consistent with expectations and issue resolution.
- Update staff success measures
If you switch to a new, automated system but the measures for staff success stay in a manual workflow, employees will continue to follow the manual process because that’s where they’re being tracked. Make sure your metrics and tracking transition with you. - Get buy-in from auxiliary departments + partners
Partner with other departments, physicians, leaders, and teams when selecting and deploying modern prior authorization. The earlier you can bring them into the discussion, the more likely they are to be active, productive participants. - Leverage training partners: superuser + new user
Once a few team members are proficient with your new automated prior authorization software, leverage peer-to-peer training. Pairing a “super user” with a novice is a proven tactic to make new users feel more supported and comfortable as they onboard. - Schedule continuing education
Schedule periodic group trainings to ensure processes are continuing and expectations are being met. - Close communication loops
Establish a communication feedback loop. When team members surface an issue and never hear about resolution or next steps, they may stop reporting issues altogether. That silence makes it difficult to maintain a high level of product performance. Leverage team meetings to close the communication feedback loop so that anytime something is resolved, staff hear about it.
Successfully leveraging automated prior authorization comes down to a proactive approach. It’s about empowering your team with the right tools, creating efficient workflows, and fostering a culture that embraces technological change. By following these key steps, you can move beyond manual, time-consuming processes and transform prior authorization for your organization. This shift won’t just improve your financial outcomes—it will also free your staff to focus on more complex tasks and, most importantly, provide a better experience for your patients.
Explore how Waystar’s prior authorization solutions can help your organization get results.