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Prior Authorization (PA) has got much higher relevance in the profession of physicians and the staffs working under them. As per PA, healthcare providers are required to collect approvals in advance from the concerned people and services before administering any treatment. Only once the approval is granted, the healthcare provider gets qualified for any sort of payment coverage.

Although PA questions the medical judgment of a physician, it is both time-consuming and usually done manually. It is reported that a good amount of resources allocated for healthcare is being spent for PA. At times, PA delay the treatment processes and influence the patient health outcomes.

According to AMA, the healthcare providers are overusing PA at the moment. Their health plans are often delaying the treatment processes. Nevertheless, the existing health plans will be using the PA because they help ensure a foreseeable future for the resource utilization control.

Furthermore, AMA says that there could be improved efficiencies in the PA process. But none of these steps can actually improve the current situation that is marked by the hassles of PA. At present, they are only effective in reducing the requirements for the implementation of PA for the improvement of practice efficiency.

Physicians need to analyze each clause in the PA in order to identify the problems and payment issues. This is of higher importance as long as the caring of the patients is concerned. As for the medications, the healthcare practices need to evaluate drug formulary data for PA requirements before dispatching the prescription to the concerned pharmacies. This guarantees that patients are able to secure healthcare benefits without any issues.

The benefits of this includes the reduction in emergency calls to the practice about PA requirements and the patient’s convinced approach to follow what is there in the prescription. Furthermore, for ensuring that healthcare practices are successfully obtaining PA when it required, they ensure that the medical records contain all the necessary information. When the required information is easily accessible, the timeline to achieve PA becomes very less. Moreover, it minimizes the physician’s role in the administrative PA process.

On top of all, sort of step therapy is required. It means other medications are tried with suboptimal results. Only after that, the physician can approve it so that the patients can go to obtain a particular drug. Another advantage of having medication history available in the medical record is that it speeds up the obtaining process of PA.

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The healthcare industry is becoming more aware of the time and costs associated with PA. As such, they have started to explore a variety of approaches to minimize PA burdens. In the opinion of AMA, an automated PA process has become predictable now. An automated PA system would be able to utilize the standard electronic transactions for improving the uniformity across health plans. It also streamlines the workflows in the healthcare system.

It is also noted that both health plans and vendors are implementing automated PA processes. They are utilizing the standard transaction procedure so that physician practices are able to contact their concerned trading partners for determining the technologies used and being available.

The healthcare organizations are required to identify what PA methods are being used and are available now until standard electronic PA processes are accessible. For this, they ought to study the advantages and disadvantages of each system and choose what fits the scenario. For example, proprietary portals are offered by many health plans for supporting PA.

These systems are much compatible and preferable to manual options like fax. However, practices are assigned with a great responsibility here. They are supposed to feed the portal with all the supporting options. In addition to that, they are required to update their systems with login information for each health plan for future uses.

As of late, secure email has turned out to be another effective PA method. With this option, it is easy for physicians to update their portals with supporting clinical documentation. They can use the same in their EHR workflow as well. Unfortunately, this technology is still in the developing state and therefore not available across all health plans.

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