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Electronic Preauthorization Manager (EPM)

Preauthorization is generally defined as a process that requires approval for performance of certain procedures or services from a payer.

The preauthorization process varies widely and in most cases, is a manual process, relying heavily on faxes and emails.

Current Process

  • Manual and paper based
  • Legibility issues with hand written claims forms
  • Information through unstructured medium - FAX and Email
  • Minimum traceability on FAX and Email
  • Manual or no centralised source of information for all transactions
  • No accurate visibility on TAT due to different reference points on each side
  • No visibility on status of request – only way is to call the payer and check
  • Potentially higher TAT on payer side as all the information sent by provider needs to be entered manually into payer systems

QuiClaims enables

  • Electronic forms for entering all the information
  • No manual hand written forms - no legibility issues
  • Reduced incidence of incomplete forms - platform enforces mandatory information
  • All submission to payer in a structured form through a Web based platform
  • Clear time stamping and view of all transactions, their statuses and history of past events
  • Accurate assessment of TAT
  • Single window dashboard for the entire cashless operations of the hospital
  • Centralized window for group hospitals
  • Direct visibility of status of request on the platform – minimum need to call the call centre
  • Online interaction for queries with history capture
  • Minimises / eliminates data entry on the payer side creating higher efficiencies and potentially better TAT.
  • Enables easy computations through electronic bill

Benefits

  • Timely and efficient means in requesting, processing, tracking and approving preauthorization
  • Standardize, speed up and minimize time and resources devoted to the preauthorization process
  • Improves the quality and timeliness of health care services
  • Minimize the TAT of payer response time
 

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