While prior authorization (PA) is essential for determining the coverage and approval of medical treatments, tests, and procedures, doing it manually wastes an average of 41 hours weekly per physician, which can compromise patient care. Representatives in over 30 states have introduced bills to reform prior authorization in 2023, urging providers and payers to transition to electronic transactions.

Prior authorization requests have risen by 61% since COVID-19 restrictions have been lifted. Despite the gradual adoption of electronic PA requests, manual processing still accounts for over 72% of these requests.

(EDI) 278 is an Electronic Data Interchange (EDI) transaction set that streamlines the prior authorization workflow. By replacing inefficient manual practices, EDI 278 reduces claim denials significantly, minimizes the need for reworking, eliminates treatment delays, and alleviates provider burnout.

How EDI Transforms Prior Authorization Workflows

Minimizing Treatment Delays

Prior authorization is crucial for obtaining payer approval for specific services or medications. On average, manual PA requests can take anywhere from one day to one month to complete, due to varying requirements across payers. This often leads to delays in patient care.

manual prior authorization

According to a survey of healthcare providers, 94% believe that PA restrictions cause delays in accessing necessary care. 89% of respondents believe PA delays have a negative impact on patient clinical outcomes. Likewise, 82% of doctors said prior authorization sometimes leads to patients abandoning a recommended course of treatment.

EDI 278 significantly reduces response times by replacing manual processes and streamlining prior authorization workflows. A Healthcare Financial Management Association (HFMA) study revealed that EDI 278 is 5.25 times faster than manual PA requests and twice as fast as requests processed via web portals. Implementing EDI 278 can greatly expedite the process, ensuring timely access to necessary healthcare services.

Combatting Provider Burnout

Prior authorization often involves complex administrative tasks, such as manually filling out forms, gathering supporting documentation, and submitting requests through multiple channels.

Physicians, on average, handle 45 PA requests per week, creating significant administrative burdens and contributing to provider burnout. EDI 278 automates these processes by enabling electronic data entry and document submission. This automation significantly reduces administrative burdens on providers.

According to the CAQH Index 2022, EDI 278 requests take 11 minutes less to process compared to manual PA requests, potentially saving providers up to 35.36 hours per physician each month. By reducing administrative burdens, EDI 278 enhances the efficiency of the PA process, empowering providers to focus more on patient care.

Mitigating Claim Denials

Approximately 80% of denied claims result from a lack of authorization or improper requests, creating significant financial burdens for providers. Streamlining prior authorization can help providers reduce claim denials.

EDI 278 enhances the accuracy and completeness of information exchanged during the prior authorization process. By electronically capturing and transmitting necessary clinical and administrative data, providers can ensure that all relevant information is included in the request. This reduces the likelihood of claim denials due to missing or incomplete information, saving time and resources spent on claim rework.

Moreover, EDI 278 also helps providers and payers promptly send and receive authorization requests. This enhanced collaboration enables proactive and early resolution of potential issues, reducing delays and the likelihood of denials.

Maximizing Cost Savings amongst PA Surge

Prior authorization has garnered attention for its inefficiencies, delays, and administrative burdens, but the cost of processing these requests manually has also increased over the years. Manual processes and paper-based workflows in prior authorization can be costly for healthcare providers.

The recent surge in PA requests has exacerbated the issue, leading to even higher administrative spending. EDI 278 eliminates the need for manual data entry, reduces paperwork, and minimizes the chances of errors or duplications.

EDI 278 enables automated and standardized prior authorization workflows, helping providers avoid unnecessary costs. The Council for Affordable Quality Healthcare (CAQH) Index 2022 reports that leveraging EDI 278 organizations can transition from a completely manual prior authorization workflow, helping them save costs of up to $645 million annually.

Transforming Prior Authorization with Astera EDIConnect

With the ever-increasing demand for efficient prior authorization in US healthcare, EDI 278 has emerged as a game-changer, replacing cumbersome manual processes. By streamlining workflows, automating administrative tasks, and enhancing data accuracy, EDI 278 reduces delays and lowers operational expenses, ultimately improving patient care and financial outcomes.

In this landscape, Astera EDIConnect takes the stage as a comprehensive solution, empowering healthcare organizations to leverage EDI 278 for streamlined prior authorization. Seamlessly integrating EDI 278 transactions, Astera EDIConnect delivers cost savings, faster response times, and reduced administrative burden, while lowering claim denial rates.

streamlining prior authorization

How Astera simplifies EDI 278 workflows to streamline prior authorization

Astera EDIConnect offers:

Data Translation and Mapping: Simplify data exchange by automating translation and mapping between different EDI formats, ensuring accurate communication with trading partners and reducing errors.

Validation and Compliance: Ensure data accuracy and compliance by performing real-time validation checks against industry standards and trading partner specifications, minimizing errors, improving data integrity, and meeting regulatory requirements.

Secure Communication: Safeguard sensitive patient information through secure communication protocols and ensuring compliance with data security regulations.

Seamless Integration with Provider Systems: Seamlessly integrate with existing provider systems, such as EHR and prior authorization software, eliminating manual data entry, reducing administrative burdens, and enhancing operational efficiency.

Real-time Updates and Communication: Enable real-time updates, prompt decision-making, and efficient coordination between providers and payers. Receive timely authorization responses, track authorization status, engage in real-time communication, and receive alerts and notifications for any changes in the authorization process.

Streamline your prior authorization process with EDI 278 and Astera EDIConnect. Join our demo session and see how you can benefit from faster, accurate, and secure data exchange between providers and payers. Improve patient care and financial outcomes with lower costs, quicker responses, and fewer denials.

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