HCSC, which has received more than 1.5 million prior authorization requests since 2022, will use an augmented intelligence tool that will make the prior authorization process up to 1,400 times faster, according to a July 13 news release from the health plan.
The tool was developed in 2021 and piloted through specialty pharmacy and behavioral health in 2022. In 2023, HCSC expanded it to inpatient acute care, long-term acute care, inpatient rehabilitation, skilled nursing care, outpatient and inpatient hospice care, home health and outpatient services.
The new tool streamlines the process by providing automatic approvals when the correct information is provided, asking providers the exact questions needed to make claim decisions and easing administrative burden by taking six minutes on average to submit a request.
Approvals that used to take 14 days are delivered instantaneously, the release said. During the pilot phase, behavioral health approvals were granted 80 percent of the time while specialty pharmacy approvals were granted 66 percent.
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