Background

Northwest Neurology needed a solution to scale their prior authorization operations in order to get patients the diagnostic procedures or treatment regimes they need faster. With on-site infusion therapy, MRI, EEG, EMG, and neurotoxin injections offered across 8 locations, Northwest Neurology not only has to balance various locations, users, and payers, but also they have to balance a mix of buy-and-bill, specialty pharmacy, and imaging authorizations.

Challenge

Northwest Neurology’s primary challenge was in following up with prior authorizations once submitted to ensure timely resolution. Manual follow-up (aka phoning payers) was eating away at their team’s efficiency and often proving ineffective at expediting prior authorization resolutions. Northwest Neurology had hired a consultant to help drive efficiencies in their prior authorization process, but with a mix of forms and portals across various payers, a team of 7 prior authorization specialists, and a mix of buy-and-bill, specialty pharmacy, and imaging authorizations, Northwest Neurology had no way of gaining unified insights into where their prior authorization process was breaking down.

Solution

SamaCare’s prior authorization platform is most commonly used for prior authorizations for buy-and-bill drugs. However, SamaCare can also be used for specialty pharmacy and select procedures. SamaCare was able to work with Northwest Neurology to ensure all of their prior authorization needs were addressed through one unified portal for submitting, tracking, renewing prior authorizations. By leveraging SamaCare, not only was Northwest Neurology able to save time on prior authorizations, they were also able to effectively identify bottlenecks and pain points in the process to minimize payer turnaround time and denials for all types of authorizations.