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

  • Enables screening for both pharmacy and non-pharmacy claims

  • Provides real-time decisions at point-of-service

  • Confirms eligibility based on program criteria

  • Provides fast, HIPAA-compliant access to patient medical and prescribing histories

  • Encourages fast adoption via an open library of criteria rules

  • Enhances satisfaction via user-friendly web interface

Ready to discover how Conduent Automated Prior Authorization Solutions can automate and accelerate claims processing for your organization?

Reach out to an expert now