Increase Revenue Yield with Prior Authorization Automation

Client Need

Like many health systems, Illinois-based Carle Health has seen an uptick in denials, especially those related to prior authorization. Across the U.S., it's estimated that as many as 15% of denials are due to authorizations, and while those denials are avoidable with the right tools and processes, they're rarely recoverable after the patient is seen. Facing increasing write-offs, Carle Health needed a solution to improve both the speed and accuracy of their prior authorization process. 

Solution

Carle Health turned to long-time solutions partner Janus Health and our Prior Authorization automation. Through our direct EviCore IntelliPath API connection, the Carle Health patient access team now conducts seamless prior authorizations for many of their top payers, including Health Alliance, Aetna, and Cigna. 

Results

Since implementing Prior Authorization, Carle Health has realized a 20% reduction in authorization-related write-offs for hospital outpatient services, with an annual net revenue impact of $2.4M. Additionally, patient access leadership estimates they're saving time equivalent to more than 6 FTEs, which allows patient access staff to focus on higher value work and a better patient experience. 

Staff loves the streamlined, reliable prior authorization process, appreciating time-saving features like:

• Automatic status updates to their EHR in real time
• Janus Health Teleport for Claims integration, speeding up clinical documentation upload and reducing human error.

”We are bringing technologies and a patient-centered approach to alleviating the complexities of managing the care authorization process."

— JESSICA GODBEY,
VP OF PATIENT ACCESS SERVICES