Prior Authorization Solution

Focus on caring for your patients and be confident that your revenue cycle is working the way it should

Automated Prior Authorization

ReferralMD’s prior authorization solution uses machine learning and AI-enabled processes that recognize patterns from payer responses. Workflows are dynamically updated to reduce denials and payment delays. Increase efficiency with hands-free processing of revenue cycle processes. With seamless payer connections, connect to payers for up-to-date benefits and patient OOP responsibilities.

With ReferralMD, healthcare practices can automate the entire prior authorization workflow. From the moment a physician refers a patient, all the way to submitting, verifying, and tracking a prior authorization. Seamlessly integrated with your existing systems 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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How Our Prior Authorization Solution Works

Prior Authorization Benefits

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 transactions.
Thousands of payer-specific rules for benefits and prior authorizations.
Self-learning to update workflows through feedback loop from payers/claims systems.

Benefits

Reduce manual effort 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 administrative 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

Improvement in turn around time for patient benefits

25%

Grow Patient Volume

Increase in patient
referrals

31%

Increase Efficiency

Productivity
improvement

22%

Accelerate Reimbursement

Reduction in claims
held in suspense