Provider Prior Authorization
Premier's Stanson Health is helping modernize prior authorization (PA) and utilization management (UM) by integrating into the electronic health record (EHR), offering a payer-agnostic solution that helps streamline the process with real-time decisions at the point of care.
Two Solutions, One Goal: Prior Authorization
ImagingGuide
Imaging UM is generally slow and expensive under the traditional PA process. The best and most cost-effective opportunity to address this problem is at the point of care. Introducing ImagingGuide. This artificial intelligence (AI)-backed tech offers guidance in the EHR with highly targeted clinical decision support (CDS) that helps select the right imaging decision at the right time for both inpatient and outpatient care. With this technology, providers can reduce unnecessary imaging that offers little to no clinical benefit to patients, all while improving patient care outcomes and reducing costs. ImagingGuide is designed to document Appropriate Use Criteria (AUC) and satisfy the Protecting Access to Medicare Act of 2014 (PAMA) mandate requirements.
AuthAssist
Stanson is revolutionizing how prior authorizations are processed by providing a muti-faceted approach that leverages technology, evidence-based guidelines, and collaboration between providers and payers. AuthAssist can be integrated into your current EHR, offering a payer-agnostic solution that helps streamline the process with real-time decisions at the point of care. Using natural language processing (NLP) and machine learning (ML), we help connect providers and payers with guidelines to determine if an order meets payer requirements for near-instant approval based on information gathered from the EHR.
Why ImagingGuide?
Improve Inpatient Reimbursement
Improve reimbursement based on diagnosis-related groups.
Improve Outpatient Imaging
Reduce care requests likely to be denied by health plans and benefits managers.
Meets AUC/ PAMA Compliance
Embedded CDS tool designed to comply with Centers for Medicare and Medicaid Services (CMS) mandate.
ImagingGuide Benefits
• Adjusts CDS guidance based on analytics to help target the most impactful ordering situations.
• Uses NLP to read data and help suppress nuisance alerts.
• Understands provider ordering patterns via ML to display the highest impact CDS only, and more.
• Reassessment of rules after the point-of-order entry and alerting to help understand what providers document after interacting with Premier's Stanson Health app.
• Designed to provide increasingly meaningful CDS from what is learned on re-evaluation.
Provider-centric, peer-comparison feedback in decision support designed to enable providers to understand and compare their performance.
Offers a growing CDS library of imaging UM alerts for all imaging areas and settings (AMB, IP, ED), not just the Priority Clinical Areas. Supports savings and quality improvements identified by literature and real-world insights in provider and payer organizations.
Designed to enable governance by displaying trending utilization, outlier and savings metrics.
ImagingGuide is foundational tech that can be used in combination with Stanson’s AuthAssist and ImagingAssure solutions, which are technologies supporting electronic submission and expedited PA reviews.
AuthAssist: Assisting Providers in Real-Time Authorization Approval
Reduce Care Delays
Providers, payers and patients can immediately experience the benefit of an automated, real-time prior authorization approval process.
Automate Clinical Reviews
Eligibility and clinical necessity are both assessed based on payer guidelines, enabling a real-time decision to be delivered at the point of care versus reviews downstream that take time.
Save Time & Expense
This improves the overall experience for everyone, including the patient, and saves both providers and payers the time and expense spent managing the manual prior authorization process.
How AuthAssist Can Help
Improve provider engagement with tech that providers can easily understand and prefer over the traditional prior authorization process.
Designed to verify medical necessity in less than a minute and avoid peer-to-peer reviews on approvable cases.
Enable near-immediate decision making with requests that can be approved in less than one day.
Reduce the number of cases that require human review with provider engagements while lowering downstream review costs.
ImagingGuide can help with imaging CDS in the EHR to guide provider decision making to help reduce clinically inappropriate and potentially harmful orders. It also works collaboratively with our payer tools such as ReviewAssist and ImagingAssure.
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