Benefits of Automated Prior Authorizations

Automate and streamline referral authorizations within the referral workflow and gain prior authorization for procedures before patient appointments

AI Enabled Processes

Prior authorization solution uses machine learning to recognize patterns. Referral workflows are dynamically updated to reduce denials and payment delays.

Seamless Payer Connections

Increase efficiency by reducing time consuming manual processes. With seamless payer connections; connect to health systems for up-to-date benefits and patient OOP responsibilities.

automated Workflow

From the moment a physician refers a patient, all the way to submitting, verifying, and tracking a prior authorization. ReferralMD seamlessly integrates with your existing practice software and workflows.

Watch this video to see how ReferralMD Can speed up prior authorization

Features

  • Autonomous execution of complex precesses
 with immediate response at point of service.

  • Medical and pharmacy benefits coverage
for over 93% of U.S. covered lives.

  • Direct connection to payers in the U.S. to support near real-time decisions.

  • Thousands of payer-specific rules for benefits
 and prior authorizations.

  • Self-learning to update workflows through feedback 
loop from payers/claims systems.

Benefits

  • Reduce time-consuming manual efforts by up to 70% and
eliminate rework by up to 90%.

  • Capture most accurate patient responsibility data 
to improve collections at point of service.

  • Reduce turnaround time by >90% to respond
 to referring physicians and patients in minutes.

  • >25% productivity gains in <6 months by
 eliminating siloed, tribal knowledge-bases.

  • Reduce denials and improve payer collections
by over 20%

Move RCM to
the Point of Service

Alternative sites of care have unique revenue cycle challenges. Limited contact with patients. Complex billing. Extreme time constraints. All of which lead to errors that trigger denied claims and write-offs. Prior authorization only magnifies these challenges.

ReferralMD automates the tedious manual tasks that plague prior authorization and moves the revenue cycle processes associated with it to the point of service so you capture more revenue, faster, and with 33% less effort.

Tangible Goals

By integrating ReferralMD with your current systems, you can:

93%

Improve Patient Experience

Improve turnaround 
time for patient benefits

22%

grow Patient Volume

Increase in patient referrals

25%

Increase Efficiency

Productivity improvement

31%

Accelerate Reimbursement

Reduce claims held in suspense

SmartEXCHANGE®

Bidirectional Integrations

We integrate with most electronic health records (EHR) systems, practice management systems (PMS), and radiology information systems (RIS) using APIs, HL7, FHIR, or Direct, and we also seamlessly connect with other HIPAA-compliant third-party systems and business intelligence tools.

Contact us if you don’t see your EHR

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Take a product tour to learn how ReferralMD drives operational efficiencies, increases revenue, improves communications and, enhances customer service