Healthcare

Improve prior authorisation processing for patients.

Speed prior authorisations 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

Healthcare & Life Sciences

Salesforce products used

Data Sources Used

Adjudicated Claims Data

Prior Authorisation 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 authorisation adjudication data to help customers decide on the appropriate action to take for a new prior authorisation request.
Predictive Models	Use models based on patient health history and past claims data to predict the likelihood that a prior authorisation request will be accepted or denied. Build models that suggest the Next Best Actions to move patients through the prior authorisation request process.

What’s the impact?

Accelerate Processing of Authorisations

Improve CMS Regulatory Compliance

Improved Patient Experience

Ready to take the next step with Data Cloud?

Talk to an expert.

Tell us a bit more so the right person can reach out faster.

Request a call

Get started.

Activate Data Cloud for your team today.

Learn more