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In the current clinical environment, complex processes and costs pose risks to health plans. Payers and patients face prior authorization (PA) challenges with:
These challenges inhibit payers from fully optimizing PA and appeals processes, decreasing costs and increasing the speed of care delivery. At a time when medical specialists have limited resources, patients/members expect their plans to provide ever-improving health experiences and outcomes.
- Lack of timely access to MD specialists for the patient
- Lack of quality reviews
- Inefficient turnaround times
- Limited clinical opinion for high cost procedures