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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:

  • Lack of timely access to MD specialists for the patient
  • Lack of quality reviews
  • Inefficient turnaround times
  • Limited clinical opinion for high cost procedures
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.