Challenge

• Limited administration capabilities in physician offices becomes significant challenge for efficiently processing ever increasingly complex pre-authorizations.
• Pre-Authorization process has significant manual processes that are time-consuming and iterative.
• This service burden and complexity increases on an average of 10-15% year over year increasing time and costs.
• Need the process to be streamlined, increase efficiencies, reduce the need for headcount to do data entry and optimize the overall case management process.
  

Solution

BlueSky implemented a fully HIPAA compliant PreAuth Portal on the Salesforce Experience Cloud platform with tight integration to Service Cloud.  Key features implemented:

• Create and maintain DRAFT versions of Pre-Auth requests.
• Submit Pre-Auth requests and view their progress in real-time.
• Receive automated notifications as Cases advance to defined milestones.
• Collaborate with inside Reps/Agents and/or Sales Rep as needed directly on the Case via Salesforce Chatter.
• View custom dashboards and reports that show All Open Cases, Cases with Actions Required, Last 30 days Closed Cases, Open Cases by Physician, Closed Cases by Physician and Cases by Physicians/quarter.
• Access to FAQs and ability to submit Support requests.
• Knowledge integration.
  

Impact

• Pre-Authorization requests are now being closed 5-7 days faster leading to increased revenue.
• No more paper copies required.  Eliminated the need to fax Patient details. Prevents office coordinators from scanning and faxing each authorization form, saving time and consumable costs.
• Increased “Stickiness” for physician practices, leading to new business from previous competitive accounts.
• Physician practices are impressed by the simplicity, registration time, and ease of navigation through submission.
• Expedites data entry and simplifies draft case management.
• It eases communication within the company.
  

Awards

• CMA Innovation Award

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