Existing Wording: Prior authorization is an essential process in the management of healthcare costs by payer organizations. However, the process of requesting and receiving prior authorizations can be slow and inefficient. U.S. regulations mandate that X12 be used for communicating prior authorization requests and responses. However, few electronic health record (EHR) systems have implemented this interface. As a result, prior authorizations are often solicited by fax or by using payer-specific portals where clinicians re-key relevant information. Fax submission requires manual transcription on the payer side - and may result in significant back-and-forth requesting additional information prior to a decision being made. Re-keying information is inefficient and can result in data entry errors.

Comment:

In my experience, Prior Auth is also supported by Practice Management solutions and Revenue Cycle Management solutions, not just EHR systems. While it is true that MOST EHR systems don't implement X12 transactions, other systems and solutions do. I would not focus on the lack of support in EHRs. Talk about other benefits of using more modern standards for communicating relevant data (e.g., FHIR and JSON), and telecommunications (RESTful APIs for near realtime interactions rather than batch-based EDI transactions).

Summary:

Prior Auth is also supported by Practice Management solutions and Revenue Cycle Management solutions.