ReferralMD Announces AI-Powered Prior Authorization Solution

ReferralMD Announces AI-Powered Prior Authorization Solution

Automates the tedious process of getting prior authorizations approved by payers

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ReferralMD, a leader in referral management and patient access, has announced that its care coordination platform now includes prior authorization automation which allows healthcare providers to automate the labor-intensive prior authorization process with payers.  This feature allows healthcare providers to significantly reduce manual processing time, decrease the number of denials, receive approvals faster, and maximize revenue.

With ReferralMD’s solution, the entire prior authorization process is automated, starting with insurance eligibility verification and prior authorization determination based on the patient’s payer, plan, and procedure.  For procedures requiring prior authorizations, the system automatically submits, monitors, and reports the status of every authorization request directly within the workflow.  The prior authorization submission route is automatically determined based on the payer requirements such as EDI/278, payer portals, or fax.

Surveys have shown that healthcare practices spend between 15 and 20 hours per week obtaining authorizations. With ReferralMD’s automated solution, there is no need to manually cut and paste data from portals, fax forms, play phone tag, or sift through emails.  Healthcare providers can reduce manual effort by up to 70% and eliminate rework by up to 90%.  By capturing the most accurate patient responsibility data, providers can improve collections at the point of service.

Thanks to significant improvements in machine learning and artificial intelligence (AI) enabled technology, prior authorizations that required time-consuming manual processes can now be completed automatically “behind the scenes.”  With automated prior authorizations, providers are able to:

  • Check patient eligibility
  • Submit a request for prior authorization
  • Send automated approval notices
  • Facilitate payer-provider collaboration
  • Automate referral of approval requests
  • Comply with the requirements of each payer.

“ReferralMD is excited to offer a truly game-changing experience to healthcare providers,” says David Bongiovanni, CEO of ReferralMD.  “Automation of the prior authorization process removes a critical bottleneck in the typical patient journey workflow, reducing wait times for patients, and improving cash flow for providers.”

About ReferralMD

ReferralMD delivers proven e-consult and referral management, patient access and engagement, telemedicine, and CRM marketing solutions which help hospitals, health systems, networks, and payers streamline the referral process, decrease patient leakage and improve communication between providers and patients. With powerful clinical decision support tools and real-time analytics, ReferralMD helps healthcare providers increase revenue, drive operational efficiencies, and improve customer service. To learn more about ReferralMD, please visit

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