Prior Authorization
Empowering Physicians to administer the Necessary Care when Patients need it most — without Hesitation
Expedite Your Payer Approval
Learn the benefits of Prior Authorization for Fast, Life Saving, and Cost Effective insurance approval process
Problem
Varying and ambiguous state and federal rules leave patients in-the-dark and providers forced to delay necessary treatment
• No Insight — Patients have No Insight / knowledge for approval or denial
• Up in the Air — It takes Days, Weeks or Longer to receive decision (If Ever...!)
• Delays — Dangerous treatment delays for Acute, Chronic and Complex conditions
• Financial and Administrative Burden — Costly Provider and Payer misalignment
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Solution
Da Vinci Payer Data Exchange (PDex) Prior Authorization Profile — Enables Payers to Communicate prior authorization Decisions and any Changes Directly to Patients
• ExplanationOfBenefit Resource is used by PDex to express claims information to members with the CARIN Blue Button® FHIR® Implementation guide (CARIN BB IG)
• CARIN Blue Button® IG — Can be customized to exclude or include prior authorization records:
— Pending and Active Decisions
— Related clinical Documentation
—Forms for items and services (not including prescription drugs)
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Benefits
• Fast Answers — no later than one (1) business day after a provider initiates prior authorization for the enrollee
• Clear understanding of pending / active decisions and related clinical documentation/ forms (not including prescription drugs)
— List of approved units and services
— Approval and Ending Date Record
— Changes of Status
• No Delays — Patients receive the Right Care at the Right Time
• Healthcare Providers greatly reduce operational and financial burden with quicker and automated process