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Healthcare provider streamlines revenue cycle management with Experian Health’s Authorizations, achieving significant gains in efficiency and patient care.
USA Health, serving over 250,000 patients annually, has dramatically improved its authorization processes, increasing daily authorizations by 100% and reducing manual work by 50%. The transformation, driven by the implementation of Experian Health’s Authorizations platform, addresses longstanding challenges with manual workflows and a rising rate of claim denials.
Prior to automation, USA Health faced significant hurdles in managing the hundreds of thousands of authorizations required across its hospitals, specialty centers, and outpatient clinics. According to a senior official at the organization, “We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to a lack of authorizations.” The existing manual processes were prone to errors, requiring staff to repeatedly print and update schedules to track changes. This resulted in missed cases, claim denials, and delays in patient care.
The challenge was compounded by the organization’s growth. As new service lines were added, the volume of authorization requests increased, placing further strain on already overworked teams. A key constraint was the decision to avoid increasing staffing levels, necessitating a technology-driven solution.
A Phased Approach to Automation
USA Health, already utilizing Experian Health for eligibility verification, selected Authorizations to optimize its workflows. The implementation, which took approximately 6-8 months, was rolled out in phases, beginning with a single service line. As staff gained proficiency, additional service lines were integrated.
The solution works by first determining if authorization is necessary. If so, the authorization is completed on the payer’s website. Experian Health’s Authorizations then tracks the status of the authorization, eliminating the need for time-consuming phone calls and portal checks. Once approved, the status is automatically updated in the Electronic Health Record (EHR). This automation extends to comparing authorized procedures with those actually performed, flagging discrepancies to prevent denials.
“The implementation process met our expectations,” stated a senior leader. “And the solution has greatly improved our authorizations process and workflows.”
Measurable Results and Increased Productivity
The impact of Authorizations has been substantial. Beyond the 100% increase in daily authorizations and 50% reduction in manual work, USA Health has successfully expanded to six service lines without adding personnel. The platform also provides accurate tracking of staff productivity, enabling performance monitoring and accountability.
Staff now utilize 30 dynamic work queues, processing approximately 130,000 authorization requests each year. These queues organize tasks in real-time by date and service line. Automated payer website checks now provide instant updates for over half of all accounts, allowing staff to focus on more complex cases.
The average number of accounts completed per employee per day has more than doubled, rising from around 20 to between 40 and 50. Monthly scorecards provide insights into accuracy and denial rates, further enhancing performance management.
Benefits for Patients and Future Expansion
The benefits of streamlined authorizations extend to patients, with fewer appointments canceled or rescheduled due to delays. According to a company release, automated prior authorizations ensure patients receive care without unnecessary waiting.
“The Experian team was instrumental in helping us pivot and develop specific workflows tailored to our needs,” said a senior official. “Together, we addressed missing payer connections and created knowledge-based rule sets to drive efficiencies.”
USA Health currently manages this improved workflow with a team of 28, and plans to continue expanding the implementation to additional service lines and facilities. The organization now possesses valuable data on staffing requirements, productivity measures, and process optimization, enabling efficient replication of successful workflows.
Looking ahead, the team plans to introduce more service lines and facilities while continuing to refine workflows and streamline processes.
Find out more about how Experian Health’s automated prior authorizations can help your healthcare organization boost productivity, reduce errors and prevent costly denials.
