Experian Health Prior Auth, also known as Authorizations, is an integrated online service designed to automate and streamline the prior authorization management process for hospitals, health systems, and ambulatory practices. The solution is built to eliminate the heavy administrative burden and high denial rates associated with manual, paper-based workflows.
Key Capabilities and Features
The software automates 100% of prior authorization inquiries by leveraging Experian Health's proprietary Knowledgebase, a comprehensive and dynamically updated repository of national and local payer prior authorization requirements. This real-time access ensures staff are working with the most current rules, significantly reducing errors and denials.
- Automated Inquiries and Submissions: The system automatically checks for authorization requirements and facilitates the submission process, only prompting users for manual intervention when necessary (exceptions-based workflow).
- AI-Guided Workflow: Artificial intelligence is used to guide users through the process and automatically direct them to the appropriate payer and connection type.
- Dynamic Work Queues: Provides an instant view of the prior authorization status (pending, denied, or authorized) and alerts staff to pending tasks, improving operational efficiency.
- Postback Service: Allows users to automatically send authorization status, number, and validity dates back to their Health Information Systems (HIS) and Practice Management Systems (PMS).
- Integrated Document Imaging: Securely receives and stores images of payer responses.
- Reconciliation: Compares authorized procedures with delivered procedures, flagging variances to proactively prevent denials and appeals.
- Seamless Integration: Designed to integrate with existing Electronic Health Record (EHR) and billing systems to adapt to current processes without requiring a complete workflow overhaul.
By automating these critical steps, Experian Health Prior Auth helps providers prevent costly claims denials, accelerate reimbursement, and free up staff to focus on patient care.
