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Season 2 • Episode 9

Prior Authorization Trends and Opportunities

 

Show Notes

While prior authorization serves as vital checks and balances, ensuring clinical quality and preventing fraud, the administrative burden it imposes on providers and payers alike has led to an industry-wide reevaluation of certain codes and an increased push towards technology for auto-approvals and Gold Carding.

Now, it's up to payers to encourage provider adoption of the technology by offering platforms with user-friendly interfaces, intuitive design, and seamless workflows.

Streamlining prior authorization improves the overall experience for payers, providers, and members to ensure timely care and a more efficient healthcare system.

Tune in to discover: 

  • Current shifts in the industry to reduce administrative burden while maintaining clinical quality and medical necessity 
  • How plans are leveraging technology to gain insights and refine prior authorization processes
  • What CMS is doing to ensure guidance and appropriate timeframes serve members' best interests

About Our Guest

Chris has been in healthcare software for nearly 20 years, working on both the provider and payer sides for operations, implementations, and product development. He has niche expertise in utilization management and prior authorization software. 

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