How Atlantic Health automated its radiology prior authorization workflow

This initiative used a combination of workflow optimization, process improvement and intelligent automation while switching to the "schedule first, then authorize" approach for its radiology services. This initiative has resulted in an average reduction of 65% in processing time for prior authorizations while also eliminating the need to spend any time on services that do not require such approvals. The submission of prior authorizations to various payers was automated through the electronic health record, saving users from entering digital information that was already available. 

In addition, the automatic verification of prior authorization and corresponding updating of info in the EHR was done through intelligent automation, which eliminated the need to check payer portals every few hours or phone insurers. While automation was at the heart of this initiative, workflow optimizations for practice operations, physicians and pre-services was simultaneously done to make it efficient. Identification of services that required authorizations, development of a physician peer-to-peer review process, creation of system tools to quickly identify services that required actions, were a few key ingredients to the success.

"It turned out that there is not one, single technology that can solve this problem. So, the idea is to use what we call intelligent automation. It's a combination of multiple technologies. It could be artificial intelligence, it could be machine learning, it could be rules-based automation, it could be robotic process automation, which is heavily used toward this initiative. It could also be predictive analytics and things like that. What we did at Atlantic Health System, we used a combination of three technologies. One is a robotic process automation, a little bit of artificial intelligence, and also rules-based automation, which is heavily used in the EHR," Aditya explained. 

The system interfaces with their Epic EHR and uses a Greystar automation hub. These work together through interfaces and then query the payer to obtain, submit and check whether or not there is an authorization. 

"So, someone needs to request an authorization for an MRI. The payer will say, 'yes you do have an authorization,' or 'you don't.' And sometimes they say, 'I don't know, it will take me two days.' So, for five days a week, you then have to check the payer website. With this automated process, they don't have to do anything. The robotic system automatically checks the payer sites and then tells the EHR  'yes,' we do have an authorization or 'you don't,'" Aditya explained.

The automated system sends the diagnosis- and procedure-related information to payers as part of the interface message. It also reuires clinical information from progress notes, details which are not usually discreet in the system. 

"Before this initiative, it used to take us 22 minutes as the average time from start to end to request a prior authorization from a payer. Now I believe we are at six minutes on an average. And it's not just that you are saving time, you are removing those people from the process. They are now doing much more meaningful patient work. That's the difference because there is so much that they need to do and they're not able to. They can do a lot of working, scheduling and authorization in other areas," he explained.

This has largely eliminated the need for staff to constantly call and wait on the phone with an insurance company, or repeatedly check the payer's website for approvals or denials. 

Atlantic Health started implementing this system with radiology in January 2022, and since it has expanded to about 90% of the health system, Aditya said.

Radiology Business previously wrote about the New Jersey-based hospital system's prior authorization intervention in April.