Electronic Prior Auths Save Time, But Don't Change Approval Rates

ePA reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.

Electronic prior authorization (ePA) can significantly reduce the time between authorization requests and payer decisions, as well as the time it takes for a patient to receive care.

However, approval rates were not impacted by ePA compared with manual processes.

That's according to an analysis of a program from America's Health Insurance Plans (AHIP) called the Fast Prior Authorization Technology Highway (Fast PATH).

Six health insurance providers—Blue Shield of California, Cambia Health Solutions, Cigna, Florida Blue, Humana, and WellCare (now Centene)—participated in the project. Availity and Surescripts were the technology partners.

An evaluation of the 12-month Fast PATH project found:

• Faster patient care: 71% of experienced providers (those who used ePA for most of their patients) who implemented ePA reported faster patient care. ePA reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
   
• Uptick in usage: In the six months after implementing Fast PATH, 62% of all prior authorizations were submitted electronically.
   
• Reduced manual work: Providers included in the sample had 48% fewer manual prior authorizations compared to the 6 months prior to implementation, but 34% more prior authorizations overall.
   
• Greater understanding: Respondents who used ePA for most of their patients said that ePA made it easier to understand if prior authorization was required (60%); easier to understand the requirements for prior authorization (57%); and easier to view the prior authorization decision (54%).
   
• Lessened administrative burden: Respondents who used ePA for most of their patients reported spending less time on phone calls and faxes after adopting ePA. 54% of reported fewer phone calls; 62% reported less time spent on phone calls; 58% reported fewer faxes; and 63% reported less time spent on faxes.

Other recent research shows the money-saving opportunities from ePA.

Automating claim transactions saved the healthcare providers, including medical and dental providers, and payers $122 billion in 2019–2020, and moving to fully electronic transactions could yield an additional $16.3 billion in savings, according to the Council for Affordable Quality Healthcare Inc. (CAQH) 2020 Index.

The report identified prior authorization as the largest savings opportunity. Converting partially electronic prior authorization transaction to fully electronic could save provider organizations $3.43 per transaction and converting a completely manual prior authorization process to fully electronic could save $6.62 per transaction.