Regardless of right now's technological advances, numerous prior authorization requests are submitted through fax machine. A brand new partnership between Blue Protect of California and Salesforce will tackle this downside.

The partnership was introduced on Monday throughout HLTH 2024 in Las Vegas. The 2 corporations will construct a brand new answer on Salesforce Well being Cloud that may allow physicians and sufferers to obtain prior authorization responses in close to real-time. Testing of the answer will start in early 2025, with a restricted rollout.

On the doctor's request, the answer searches the affected person's digital well being report for related medical info and organizes it right into a pre-populated digital kind. Medical doctors can then submit prior authorization requests instantly by way of their techniques, and sufferers obtain responses throughout medical appointments.

If a case requires a medical session, the doctor will obtain a message explaining what is required to finish the prior authorization request. Usually this course of can take days, however the brand new answer goals to scale back this to hours. Sufferers additionally obtain updates on their prior authorization requests by way of the Blue Protect member app. Any denial of a request shall be made by a medical director or licensed doctor, the announcement stated.

Prior authorization is a controversial subject for suppliers and payers, with a variety of finger-pointing between each events. Suppliers argue that this creates administrative burdens and delays affected person care. In accordance with the American Medical Affiliation, 78% of physicians report that issues with prior authorization trigger sufferers to forego care. Payers, in the meantime, argue that the method is critical to stop pointless care and cut back prices. The partnership between Salesforce and Blue Protect of California goals to make this subject much less tense.

“You don't must level fingers if there isn't an issue,” stated Jeff Amann, govt vice chairman and normal supervisor of Salesforce Industries, in an interview. “That's the objective. After all there shall be exceptions, however these exceptions are studying alternatives for the enterprise system.”

Paul Markovich, CEO of Blue Protect of California, stated the businesses need to make prior authorization as straightforward as utilizing a bank card with their new answer.

“To me, the largest factor we will do — and that is what I feel well being care plans are most responsible for — is create a system the place it's like utilizing a bank card,” Markovich stated in an interview. “Generally your bank card says, 'Oops, wait, name this quantity.' That can even occur on this course of and you’ll instantly get somebody on the cellphone. You’ll be able to speak to a physician, you may make an appointment at a handy time, there’ll at all times be a human within the know for a sure time frame for which we can’t totally approve prior consent.”

Though Blue Protect of California helped develop this answer, the businesses hope different insurance coverage corporations will use it sooner or later, Markovich and Amann stated.

Picture: Piotrekswat, Getty Photographs