Automate Prior Authorizations

Focus on caring for your patients. ReferralMD automatically checks health plans and reduces manual tasks associated with prior authorization.

Automated Prior Authorization

ReferralMD’s prior authorization solution uses machine learning and AI-enabled processes to recognize patterns from health systems. Workflows are dynamically updated to reduce denials and payment delays. 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.

ReferralMD healthcare practices are automating prior authorization workflows. 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.

No need to manually cut and paste data from portals. No need to fax forms, play phone tag, or sift through emails. ReferralMD connects directly with your EHR, LIMS, pharmacy management, or revenue cycle solution.

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Watch a video to see how our prior authorization system works

Speed Up Your Prior Authorization Process

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 Results

By integrating ReferralMD with your current systems, you can:

93%

Improve Patient Experience

Improve turnaround 
time for patient benefits

25%

Grow Patient Volume

Increase in patient referrals

31%

Increase Efficiency

Productivity improvement

22%

Accelerate Reimbursement

Reduce claims held in suspense

Solve Your Interoperability Challenge

We integrate with most electronic health records (EHR) systems, practice management systems (PMS), and radiology information systems (RIS) with APIs, HL7, FHIR, or Direct.

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See how ReferralMD delivers a better experience for providers, staff, and patients.

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