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95% adopted electronic claim submission

            87% of physicians have adopted HER

            70% adopted e-prescribing

            8% adopted prior authorization ePA

                                                                Unlike electronic claims, e-prescribing and eligibility
                                                                checking individual states have not forced
                                                                insurance companies at the local level to adhere to
                                                                long-established standards, delaying the ePA adaption.

                                                                Moving beyond the basic information requirements
                                                                such as requesting physician, patient, insurance,
                                                                demographics, CPT, and ICD-10 codes, the insurance
                                                                companies are looking for justification why the testing
                                                                was necessary. Often this requires supporting
                                                                documentation such as previous treatments, medical
                                                                records, and lab results to support the request.

                                                                Pre-authorization for outpatient services is reasonably
        As the demand for manual and electronic PA increases,   managed; however, in a physician office setting if for
        decisions need to be made based on the cost of doing    example, a molecular test is ordered the pre-authorization
        business in a pre-authorization environment as the current   process for laboratory testing is not well defined.
        workflow is not sustainable.                            Physician practice management vendors are slowly sorting

        •   Continue to develop an in-house process with        out the pre-authorization puzzle; however, laboratories
             dedicated staff that specializes in this process?  could seize this as an opportunity to provide a better
        •   Outsource this process to vendors who specialize    experience for their physician clients by championing
             in the handling of ePA?                            change in the current process. Laboratories could build
        •   Deploy a software solution to handle the ePA        a decision support engine to determine if prior
            demands that integrate seamlessly within            authorizations are needed or not needed based on
            the physician’s practice management/EHR             predefined criteria such as type of procedure, CPT,
            system through API’s or an HL7 interface?           ICD-10, and insurance could be a good start.
                                                                Laboratories are the experts tracking turn-around-times
        Why is the process of migrating from a cumbersome       TAT for tests; perhaps they can bring their expertise
        manual process to ePA so slow considering the standard   to create TAT for PA requests.
        has been around for years? The reason for this technology
        gap is due to the challenges of software vendors to
        reconcile the variables of over 2000 insurance companies,
        each with their own prior authorization request form
        and procedures.
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