Preauthorization is generally defined as a process that requires approval for performance of certain procedures or services from a payer.
The preauthorization process varies widely and in most cases, is a manual process, relying heavily on faxes and emails.
Current Process
- Manual and paper based
- Legibility issues with hand written claims forms
- Information through unstructured medium - FAX and Email
- Minimum traceability on FAX and Email
- Manual or no centralised source of information for all transactions
- No accurate visibility on TAT due to different reference points on each side
- No visibility on status of request – only way is to call the payer and check
- Potentially higher TAT on payer side as all the information sent by provider needs to be entered manually into payer systems
QuiClaims enables
- Electronic forms for entering all the information
- No manual hand written forms - no legibility issues
- Reduced incidence of incomplete forms - platform enforces mandatory information
- All submission to payer in a structured form through a Web based platform
- Clear time stamping and view of all transactions, their statuses and history of past events
- Accurate assessment of TAT
- Single window dashboard for the entire cashless operations of the hospital
- Centralized window for group hospitals
- Direct visibility of status of request on the platform – minimum need to call the call centre
- Online interaction for queries with history capture
- Minimises / eliminates data entry on the payer side creating higher efficiencies and potentially better TAT.
- Enables easy computations through electronic bill
Benefits
- Timely and efficient means in requesting, processing, tracking and approving preauthorization
- Standardize, speed up and minimize time and resources devoted to the preauthorization process
- Improves the quality and timeliness of health care services
- Minimize the TAT of payer response time
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