Healthcare
Improve prior authorization processing for patients.
- Speed prior authorizations to improve member experiences, satisfaction, and outcomes.
- Adhere to regulatory timelines with built-in compliance and automation at every step.
Use case summary
Use historical claims data to power actionable insights and AI that ensure faster processing and compliance with regulatory timelines.
Industry
Data Sources Used
Adjudicated Claims Data
Prior Authorization Data
Apply Insights and Predictions
By bringing together the data sources referenced in this use case, teams can build calculated insights or run predictive models with Data Cloud that will allow them to make smarter decisions or power new automations.
| Calculated Insights | Use historical claims data to generate insights that identify patterns regarding past case history. Build insights by combining past claims and prior authorization adjudication data to help customers decide on the appropriate action to take for a new prior authorization request. |
| Predictive Models | Use models based on patient health history and past claims data to predict the likelihood that a prior authorization request will be accepted or denied. Build models that suggest the Next Best Actions to move patients through the prior authorization request process. |
What’s the impact?
Accelerate Processing of Authorizations
Improve CMS Regulatory Compliance
Improved Patient Experience
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