Prior authorization is supposed to save healthcare dollars. Too often, it’s a cost sink instead—consuming invaluable time, money and resources. Initial prior authorization reviews cost payers an average of $80 to $120 per review, or $18.4 billion annually. Inefficient prior authorization processes that leave behind dissatisfied patients and members are a problem for all health plans and providers.

Today’s technology can deliver solutions that automate the prior authorization process with accuracy and support more transparent clinical decisions. With the right components, payers and providers can collaborate on providing care seamlessly and delivering new member experiences fit for the era of value-based care.

This paper reviews recent regulations, details prior authorization best practices, and shares the benefits health plans can derive from modern prior authorization practices and technology.