Payer interest in Computerized DME Prior Authorization is expanding. Initially, automation in many firms mirrored the paper process, necessitating redundant data entry. However, considerable progress is being made toward a standards-based, real-time ability to manage DME prior authorizations electronically as part of the electronic prescribing process. Adoption is being accelerated by industry activities, provider pushback, and laws.

Most payers are rediscovering their interest in these activities, but many are unsure where to direct their attention. In fact, at various stages of the computerized DME PA evolution, the terrain is littered with plans. In actuality, there are early adopters, mature automated payers, and payers with varying levels of maturity depending on the area of business. To be honest, not all of these adjustments are going as well or as smoothly as they could be. The industry’s progress is fast, with new standards and use cases emerging to address some existing difficulties and drugs left out of the process, not to mention the growing impact of federal and state laws.

The meaning of Prior Authorization

Prior Authorization should be considered as a multi-transactional, evidence-based utility for cost reduction, rather than just increasing administrative stages, utilizing incentives, or a mix of the two. Progressive payers have prioritized computerized DME Prior Authorization across a wide range of

  • Business and technological drivers
  • Areas of business
  • Customer-specific limitations

Overall computerized DME PA initiatives must account for these complications. Successful tactics understand that not all computerized DME PA is created equal.

What factors influence provider adoption?

Traditional knowledge argues that traditional carrots (incentives) and sticks (punishments) encourage providers (reductions in payments). While this is true, there are other factors at work with computerized DME Prior Authorization. Interestingly, workload and workflow integration have recently surfaced as drivers of physician uptake. Three-quarters of physicians (specialists and primary care) report a significant burden of Prior Authorization. However, Prior Authorization is not going away.

According to the American Medical Association (AMA), the Prior Authorization procedure represents the type of clerical labor that now consumes over half of physicians’ time in the office, with direct clinical care accounting for less than 30% of the day.

These rising distractions from patient care are the most common source of professional discontent among physicians. Portals do not maximize the value of computerized DME PA for providers. They provide a more automated approach, but they still require clinicians to enter into and navigate a distinct web system for each patient’s health plan. These considerations are boosting provider associations’, particularly the AMA’s, need for a computerized DME Prior Authorization solution.

Workflow information accuracy

Despite years of investment, payers continue to struggle to ensure accurate information is available at the time of prescribing and care decisions to enable computerized DME Prior Authorization. Potential Prior Authorization inconsistencies in electronic prescribing workflows, such as the necessity for Prior Authorization for a specific patient or treatment, are sometimes perplexing or inconclusive for prescribers. Prior Authorization “flags” are frequently absent. Providers will not use computerized DME PA if they believe it is based on inaccurate data, so undermining the goal and benefits of computerized DME Prior Authorization.

Key pointers in computerized DME Prior Authorization

Since the past few years, there has been a massive overhaul in the healthcare sector. Several healthcare providers have started to apply for automated and computerized programs rather than opting for manual ones. This benefited them by:

  • Minimizing errors
  • Flexible approach
  • Better follow up

Computerized DME Prior Authorization enable a payer to concentrate on essential technical and process improvements that will boost ROI.

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