Questions to ask any Prior Authorization vendor

Every vendor in this category demos well. These are the questions that separate a product that will work on your volume, payer mix, and staff from one that works in the sales deck. Take them into the demo.

1. 1

   For our top 20 auth-requiring services, what share completes touchless?

2. 2

   How do you determine auth requirements: live payer rules, or a static database that goes stale?

3. 3

   What happens when the payer requires a portal, fax, or phone call your system cannot reach?

4. 4

   How is clinical documentation assembled and checked against payer criteria before submission?

5. 5

   How will you handle the CMS-0057 API transition as payers turn on FHIR prior auth?

6. 6

   What are approval-rate and turnaround improvements at named customers with our specialty mix?

7. 7

   Does pricing scale per auth, per provider, or per site, and what do denied-then-appealed auths cost?

8. 8

   Who monitors expiring auths and renewals, you or us?