In recent times, approvals for various treatment and clinical care options could take as long as two weeks. A new claims submission tool, however, now lays claim to cutting that time to six minutes.
The new tool uses artificial intelligence to run through data, and past claims, and provide auto-approval based on certain criteria.
The AI was first developed in 2021 and now can be used for long-term care and inpatient hospice care within the Health Care Service Corporation system. The company announced its expansion of its prior authorization tool to new specialties last week.
“We recognize that providers and payers need to work together to help make the healthcare process easy to use and effective to benefit our members,” HCSC Chief Clinical Officer Monica Berner, MD, said in a statement. “For us, ‘fixing’ prior authorization so it works better for everyone isn’t a new idea, and we’re happy to see others in the industry moving in that direction as well.”
HCSC operates in five states and provides services to roughly 18 million members. The company said it had 1.5 million prior authorization requests last year.
Speeding up or digitizing the claims process is a goal of both providers and the federal government.
The Centers for Medicare & Medicaid Services first began seeking public input on the use of AI for Medicare Claims in 2019.
Last year, CMS proposed a rule that would require certain providers to have an electronic prior authorization process. The proposal also called for publicly reporting metrics and shortening the time frame for nonurgent requests to within one week, McKnight’s Long-Term Care News reported.
The agency is still reviewing public comments for inclusion in the final rule draft, according to CMS’s latest update.
