AI and Automation Drive Touchless Prior Authorization for More than 70% of Covered CPT Codes

WINTER PARK, Fla.: Humata Health, the leader in delivering AI-powered touchless prior authorizations, today announced that Allegheny Health Network (AHN) is the first health system to implement truly touchless medical prior authorization. By simply entering an order for a procedure into an electronic health record (EHR), AHN can now receive prior authorization from payers without any other human intervention, thanks to Humata’s artificial intelligence and automation technology.

In the first month, 70% of requests for Current Procedural Terminology (CPT) codes covered under this initiative have been approved without any involvement from AHN staff after care teams placed an order in the EHR. This touchless prior authorization initiative is powered by technology from Humata Health that was first applied to select imaging and radiology procedures, and is now being expanded to cover additional procedures and service lines.

This landmark achievement builds on AHN’s previous success in its partnership with Humata Health. Together, AHN and Humata have already been automating more than 200,000 prior authorizations annually, with a first-pass approval rate of 96%. This is possible thanks to Humata’s artificial intelligence and automation technology that quickly bundles and submits the right clinical information about a patient and procedure that makes it easy for payers to provide authorization.

“Lifting administrative burden from our care teams, while speeding the path to care for patients is central to our goal of providing remarkable experiences for both our clinicians and those we serve,” said Morgan Kroskie, Corporate Director, Central Authorization Department at Allegheny Health Network. “This innovative technology by Humata is delivering significant value to our organization in that regard through its touchless prior authorization capability, and we look forward to expanding our use of the solution across a broader spectrum of procedures and service lines.”

Humata’s touchless prior authorization technology automates the end-to-end process for AHN, including:

• Authorization Determination. After an order is submitted, the platform verifies if prior authorization is required for the specified CPT code.
• Clinical Package Generation. Humata automatically selects, indexes and classifies clinical information tailored to a procedure’s requirements and a health plan’s policies.
• Submission. Integration with payers and delegated entities allows for seamless clinical documentation exchange and automatic submission from the Humata platform.
• Status checks. Humata automatically monitors prior authorization submissions and regularly checks on status to proactively update care teams, only asking for human intervention in the event of a denial or if peer-to-peer review is required.
• Post-authorization monitoring. For 14 days post-procedure, the platform continuously monitors approved authorizations for any changes that could invalidate them – such as changes to the patient’s insurance coverage, diagnosis codes added or removed, rescheduling a procedure outside of the originally authorized date range, and more.

“As a practicing physician, I lived through the hassle of prior authorization – the negative impact it could have on getting patients the care they need, and the frustration of endless cycles of administrative processes that took time away from actually practicing medicine,” said Jeremy Friese, MD, Chairman and CEO of Humata Health. “AHN has been a fantastic partner in our shared goal of making truly touchless prior authorization a reality. We’ve proven that we can do it, and now we’re going to take it to scale.”

About Allegheny Health Network
Allegheny Health Network is an integrated health care delivery system serving the greater Western Pennsylvania region. More than 2,600 physicians and 22,000 employees serve the system's 14 hospitals as well as its ambulatory medical and surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations.

About Humata Health
Humata Health is the leader in delivering AI-powered touchless prior authorizations. With the industry’s largest ecosystem of integrations and proprietary technology that gathers the right clinical information required for fast approval, the Humata platform is the only truly end-to-end prior authorization solution for all services and procedures. Humata Health is a physician-led company backed by a syndicate of strategic healthcare investors including Blue Venture Fund, LRVHealth, Optum Ventures, .406 Ventures, and Highmark Ventures. For more information, visit www.humatahealth.com.

Fonte: Business Wire