Providers

NICA and SamaCare’s “Unifying Prior Authorization Data: Unique Challenges and Opportunities for Infusion Centers” Webinar Highlights

The SamaCare Team

The SamaCare Team

This week, SamaCare co-hosted a webinar with the National Infusion Center Association (NICA), DENT Neurologic Institute, and Northwest Neurology on how infusion centers can benefit from unifying prior authorization data. 

We’re all familiar with some of the challenges associated with unifying prior authorization data – namely, prior authorizations are inconsistent across payers. Some payers have forms that must be faxed, while others have portals for electronic submission. Processes for submitting and managing prior authorizations may even be different across practice locations if there is no unified system to operationalize standard practices. However, by using a tool like SamaCare practices can easily unify prior authorizations with a big upside. What is the value of unifying your practices prior authorization data? Here are our key takeaways from the webinar. 

What Metrics Are Impactful to Look at In Aggregate?

  • Average time to prior authorization resolution by payer
  • Volume of prior authorizations submitted by payer, percent approved/denied
  • Average time to prior authorization resolution by J-Code
  • Percent of prior authorizations approved by J-Code, payer, on first submission 

How Can You Use Unified Prior Authorization Data?

Conflict Resolution with Payers 

For example, one practice on the webinar was having issues with the turnaround time for a particular medication from a new payer in their region. Average turnaround time across payers was 1.4 days. However, this new payer was averaging 7.2 days to resolve a prior authorization. The practice was able to take this information to the new payer which motivated them to investigate and resolve the bottleneck – to everyone’s benefit. 

Reduce the Number of Unnecessary Prior Authorizations

One practice discovered that for a particular J-Code their prior authorization approval rate was 99%. They took this information to their top payers and were able to waive prior authorization requirements for this medication, as long as they stayed within FDA guidelines. 

Improve Patient Experience

With more predictability around time to resolution by J-Code, practices noted the ability to  better schedule patients for their first treatment, and avoid delays caused by a prior authorization not being approved by the intended date of service. 

Improve Patient Care

One practice was able to compare data on prior authorization renewals and patient compliance with a treatment regime. They discovered time lag to resolution on prior authorization renewals created disruptions to patient care and were associated with negative impacts on patient compliance. They communicated this information to payers and were able to align on a resolution strategy. 

These are just a few examples of how current SamaCare practices use their aggregate data and insights to improve practice operations and patient care. It can be overwhelming to get started wrangling prior authorization data, but one SamaCare partner has advice for practices considering the task – 

“Don’t let fear and uncertainty from your staff be a barrier to adopting technology to streamline prior authorizations,” said Christine Mann, COO of DENT Neurologic Institute. “At the end of the day, tools like SamaCare will make the lives of your staff easier and make your practice run more smoothly.”

This week, SamaCare co-hosted a webinar with the National Infusion Center Association (NICA), DENT Neurologic Institute, and Northwest Neurology on how infusion centers can benefit from unifying prior authorization data. 

We’re all familiar with some of the challenges associated with unifying prior authorization data – namely, prior authorizations are inconsistent across payers. Some payers have forms that must be faxed, while others have portals for electronic submission. Processes for submitting and managing prior authorizations may even be different across practice locations if there is no unified system to operationalize standard practices. However, by using a tool like SamaCare practices can easily unify prior authorizations with a big upside. What is the value of unifying your practices prior authorization data? Here are our key takeaways from the webinar. 

What Metrics Are Impactful to Look at In Aggregate?

  • Average time to prior authorization resolution by payer
  • Volume of prior authorizations submitted by payer, percent approved/denied
  • Average time to prior authorization resolution by J-Code
  • Percent of prior authorizations approved by J-Code, payer, on first submission 

How Can You Use Unified Prior Authorization Data?

Conflict Resolution with Payers 

For example, one practice on the webinar was having issues with the turnaround time for a particular medication from a new payer in their region. Average turnaround time across payers was 1.4 days. However, this new payer was averaging 7.2 days to resolve a prior authorization. The practice was able to take this information to the new payer which motivated them to investigate and resolve the bottleneck – to everyone’s benefit. 

Reduce the Number of Unnecessary Prior Authorizations

One practice discovered that for a particular J-Code their prior authorization approval rate was 99%. They took this information to their top payers and were able to waive prior authorization requirements for this medication, as long as they stayed within FDA guidelines. 

Improve Patient Experience

With more predictability around time to resolution by J-Code, practices noted the ability to  better schedule patients for their first treatment, and avoid delays caused by a prior authorization not being approved by the intended date of service. 

Improve Patient Care

One practice was able to compare data on prior authorization renewals and patient compliance with a treatment regime. They discovered time lag to resolution on prior authorization renewals created disruptions to patient care and were associated with negative impacts on patient compliance. They communicated this information to payers and were able to align on a resolution strategy. 

These are just a few examples of how current SamaCare practices use their aggregate data and insights to improve practice operations and patient care. It can be overwhelming to get started wrangling prior authorization data, but one SamaCare partner has advice for practices considering the task – 

“Don’t let fear and uncertainty from your staff be a barrier to adopting technology to streamline prior authorizations,” said Christine Mann, COO of DENT Neurologic Institute. “At the end of the day, tools like SamaCare will make the lives of your staff easier and make your practice run more smoothly.”

Providers

NICA and SamaCare’s “Unifying Prior Authorization Data: Unique Challenges and Opportunities for Infusion Centers” Webinar Highlights

The SamaCare Team

The SamaCare Team

This week, SamaCare co-hosted a webinar with the National Infusion Center Association (NICA), DENT Neurologic Institute, and Northwest Neurology on how infusion centers can benefit from unifying prior authorization data. 

We’re all familiar with some of the challenges associated with unifying prior authorization data – namely, prior authorizations are inconsistent across payers. Some payers have forms that must be faxed, while others have portals for electronic submission. Processes for submitting and managing prior authorizations may even be different across practice locations if there is no unified system to operationalize standard practices. However, by using a tool like SamaCare practices can easily unify prior authorizations with a big upside. What is the value of unifying your practices prior authorization data? Here are our key takeaways from the webinar. 

What Metrics Are Impactful to Look at In Aggregate?

  • Average time to prior authorization resolution by payer
  • Volume of prior authorizations submitted by payer, percent approved/denied
  • Average time to prior authorization resolution by J-Code
  • Percent of prior authorizations approved by J-Code, payer, on first submission 

How Can You Use Unified Prior Authorization Data?

Conflict Resolution with Payers 

For example, one practice on the webinar was having issues with the turnaround time for a particular medication from a new payer in their region. Average turnaround time across payers was 1.4 days. However, this new payer was averaging 7.2 days to resolve a prior authorization. The practice was able to take this information to the new payer which motivated them to investigate and resolve the bottleneck – to everyone’s benefit. 

Reduce the Number of Unnecessary Prior Authorizations

One practice discovered that for a particular J-Code their prior authorization approval rate was 99%. They took this information to their top payers and were able to waive prior authorization requirements for this medication, as long as they stayed within FDA guidelines. 

Improve Patient Experience

With more predictability around time to resolution by J-Code, practices noted the ability to  better schedule patients for their first treatment, and avoid delays caused by a prior authorization not being approved by the intended date of service. 

Improve Patient Care

One practice was able to compare data on prior authorization renewals and patient compliance with a treatment regime. They discovered time lag to resolution on prior authorization renewals created disruptions to patient care and were associated with negative impacts on patient compliance. They communicated this information to payers and were able to align on a resolution strategy. 

These are just a few examples of how current SamaCare practices use their aggregate data and insights to improve practice operations and patient care. It can be overwhelming to get started wrangling prior authorization data, but one SamaCare partner has advice for practices considering the task – 

“Don’t let fear and uncertainty from your staff be a barrier to adopting technology to streamline prior authorizations,” said Christine Mann, COO of DENT Neurologic Institute. “At the end of the day, tools like SamaCare will make the lives of your staff easier and make your practice run more smoothly.”

This week, SamaCare co-hosted a webinar with the National Infusion Center Association (NICA), DENT Neurologic Institute, and Northwest Neurology on how infusion centers can benefit from unifying prior authorization data. 

We’re all familiar with some of the challenges associated with unifying prior authorization data – namely, prior authorizations are inconsistent across payers. Some payers have forms that must be faxed, while others have portals for electronic submission. Processes for submitting and managing prior authorizations may even be different across practice locations if there is no unified system to operationalize standard practices. However, by using a tool like SamaCare practices can easily unify prior authorizations with a big upside. What is the value of unifying your practices prior authorization data? Here are our key takeaways from the webinar. 

What Metrics Are Impactful to Look at In Aggregate?

  • Average time to prior authorization resolution by payer
  • Volume of prior authorizations submitted by payer, percent approved/denied
  • Average time to prior authorization resolution by J-Code
  • Percent of prior authorizations approved by J-Code, payer, on first submission 

How Can You Use Unified Prior Authorization Data?

Conflict Resolution with Payers 

For example, one practice on the webinar was having issues with the turnaround time for a particular medication from a new payer in their region. Average turnaround time across payers was 1.4 days. However, this new payer was averaging 7.2 days to resolve a prior authorization. The practice was able to take this information to the new payer which motivated them to investigate and resolve the bottleneck – to everyone’s benefit. 

Reduce the Number of Unnecessary Prior Authorizations

One practice discovered that for a particular J-Code their prior authorization approval rate was 99%. They took this information to their top payers and were able to waive prior authorization requirements for this medication, as long as they stayed within FDA guidelines. 

Improve Patient Experience

With more predictability around time to resolution by J-Code, practices noted the ability to  better schedule patients for their first treatment, and avoid delays caused by a prior authorization not being approved by the intended date of service. 

Improve Patient Care

One practice was able to compare data on prior authorization renewals and patient compliance with a treatment regime. They discovered time lag to resolution on prior authorization renewals created disruptions to patient care and were associated with negative impacts on patient compliance. They communicated this information to payers and were able to align on a resolution strategy. 

These are just a few examples of how current SamaCare practices use their aggregate data and insights to improve practice operations and patient care. It can be overwhelming to get started wrangling prior authorization data, but one SamaCare partner has advice for practices considering the task – 

“Don’t let fear and uncertainty from your staff be a barrier to adopting technology to streamline prior authorizations,” said Christine Mann, COO of DENT Neurologic Institute. “At the end of the day, tools like SamaCare will make the lives of your staff easier and make your practice run more smoothly.”