Automated Prior Authorization (PA) Systems
Automate and accelerate claims processing
For state Medicaid programs, manual call center processes can be time-consuming and costly, often negating savings gained by controlling prescribing practices.
Conduent’s Automated Prior Authorization Solutions automate up to 90% of prior authorization (PA) processes. Built on programs’ existing claims processing capabilities, our solutions review member-specific clinical and coverage histories and confirm if prescribed therapies meet current prescribing rules.
We verify PAs for regularly prescribed and specialty medications, as well as non-pharmacy services and equipment in real time, ensuring appropriate therapies are dispensed while using fewer resources from your call center – and your budget.
How automated prior authorization systems speed processes
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Enables screening for both pharmacy and non-pharmacy claims
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Provides real-time decisions at point-of-service
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Confirms eligibility based on program criteria
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Provides fast, HIPAA-compliant access to patient medical and prescribing histories
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Encourages fast adoption via an open library of criteria rules
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Enhances satisfaction via user-friendly web interface