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Outcomes

Providers and Health Plans Connect to Fast Track Prior Authorization, Claims, and Quality Reporting

Using Payer Platform, Mayo Clinic and BCBS MN reduced ADR denials by up to 75%; Baptist Health and Humana automatically exchanged 24,000 charts in one year; and Ochsner Health and Humana completed 53% of prior authorizations instantly.

Mayo Clinic, Baptist Health, and Ochsner Health are among the growing list of approximately 85 provider organizations working with health plans to reduce administrative burden, facilitate value-based performance, and help patients receive timelier care. On the health plan side, the automation of rich clinical data exchange is improving health outcomes and quality, informing care management outreach, and simplifying claims adjudication. Using Payer Platform, Mayo Clinic and Blue Cross Blue Shield of Minnesota (BCBS MN) reduced denials due to additional documentation requests (ADR) for hospital billing by 75% and for professional billing by 63%, Baptist Health and Humana automated the exchange of 24,000 charts in one year for more comprehensive health records, and Ochsner Health and Humana completed 53% of prior authorizations instantly and automatically.

How They Did It:

  • Closed care gaps with automated clinical and claims data exchange
  • Automated clinical document exchange to improve communication between providers and health plans
  • Reduced administrative overhead by automating prior authorization

Read the full article at EpicShare.org.