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Healthcare Utilization Management for Health Plans

Automate the entire prior authorization process in months, significantly reducing administrative burden on provider and health plan staff as well as time-to-treatment for patients

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Automate the entire prior authorization process in months, significantly reducing administrative burden on provider and health plan staff as well as time-to-treatment for patients

Prior authorization is an effective cost-control tool for health insurers that plays a key role in patient safety. However, it is a cumbersome process, ridden with time-consuming back-and-forths between Healthcare Providers (HCPs) and health plan liaisons. Today, many of these interactions are over-reliant on manual, inefficient workflows, resulting in dissatisfied HCP staff, delayed care, and higher-than-necessary operational costs for health plans.

The concept of real-time prior authorization, where HCPs answer questions and receive attestation with a few clicks, is not new.  However, it has proven much easier said than done. Off-the-shelf solutions digitize specific parts of the process, but are limited in their ability to integrate with existing back-end systems and accommodate bespoke business rules at scale.  Meanwhile, custom-built solutions are impractical, as developing content and business rules for a single procedure group might take two months and cost $200K—and there are 100+ procedure groups!  

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This is why leading health plans are using Unqork’s enterprise no-code development platform to build dynamic, content-agnostic workflows and presentation layers.  With prior authorization, we enable clients to display a series of dynamic questions to HCPs, using a scalable mechanism that automatically conforms to the content pulled from underlying systems.  In other words, once a client develops the infrastructure, it immediately scales to accommodate additional procedure group “packages” of Q&A content, business rules, and metadata.  This “one-to-many” infrastructure takes only 2-4 months to design, test and deploy.  Real-time status updates can also be pushed into member-facing portals (whether or not that portal was built using Unqork).