The Evaluation between Manual vs. Electronic DME Prior Authorization

Disruptive technology and business strategy breakthroughs are regularly altering the real-time dimensions of the healthcare industry in every aspect. Leading providers and payers are seeking cutting-edge business strategies to help them expand their operations.

In healthcare, what is an HME/DME prior authorization?

When it comes to pricey prescription drugs, DME prior authorization (PA) is frequently used. Health insurance companies employ DME prior authorization to ensure that a medicine, treatment, or therapy is medically necessary before it is performed or administered.

DME Prior Authorization services are widely cited as the foundational mainstay that influences the financial stability of a practice. Enabling the appropriate checks and balances is a critical feature that necessitates improved consulting skills for effective upgradation.

Obstacles in the Manual DME Prior Authorization process

True, studies have shown that using paper for prior authorization typically causes the patient-centric model to be delayed.

• It is estimated that about 70% of patients do not receive the exact treatment that their physician ordered!

• In-house staff devotes at least 20 hours each week to perform the paperwork associated with authorization services.

Digital efficiency is gaining traction

In healthcare, medication processes are becoming more digital, allowing for essential automation.

• The new capabilities in EMR that are already available are preventing unnecessary communications between the insurers and pharmacies.

• Additional value is provided by automated task list development with detailed forms on DME prior authorization.

How do you begin the automated DME prior authorization process?

To speed up the procedure, the pharmacies with whom you are connected will send requests for authorizations electronically, similar to how refill requests are sent. The synchronized attempt will make it easier for you to receive timely notices from pharmacies compared to the late intimations through phone or fax.

Electronic submissions will aid you in the following ways:

• Speeding up the verification process, completed categories in forms are updated with patient information as well as practice facts from the EMR, in-turn saving time.

• Keeping track of the status of DME Prior authorizations after they've been submitted.

• Making your practice proactive in medication-awareness with fewer prescription hold-ups.

The following are the main advantages:

• When you confirm e-prescribe with formulary enablement, it allows the EMR to automatically check the plan coverage.

• Automatic notification to the prescriber about a prescription that requires DME prior authorization via a system-generated notification.

• A separate notification will create a new task segment for DME Prior authorization that will be delegated for completion within 24 hours.

Hence to conclude, there is no doubt that the computerized procedure will provide the necessary efficiency and better dimensions in eligibility verification services by using a thorough methodology.