Brillio Medical Prior Authorization: 4-6 Week Assessment


Streamline and expedite the Proir Authorization process, benefiting both Payers and Providers through GenAI

Background: The current manual prior authorization processes put a heavy administrative and financial burden on both payers and providers resulting in increased operational costs, patient dissatisfaction, and ineffective patient care. Below are few of the major challenges faced by the healthcare industry. • Time consuming manual reviews and verifications of health card, medical records delay care delivery • Ensuring transparency and prompt communication for PA approvals is missing • Doctors spend ~six hours daily attending to administration, leading to physician burnout • Payers are vulnerable to compliance violations while providing clarifications • Processing of PA requests requires a dedicated team of medical staff. Payers also have a separate team for responding to provider calls leading to high operational costs

Solution: Brillio's Prior Authorization Automation addresses these inefficiencies through a transformative solution leveraging AI and automation. This solution streamlines and expedites the PA process, benefiting both payers and providers.

  1. AI-Powered Automation: • Creates partially or fully automated interfaces using AI • Integrates seamlessly with existing Prior Auth Systems for validation and submission

  2. Paper-Based and Digital Submission: • Supports paper-based, partially-automated submissions via fax or mail through Capture AI, which extracts information with high accuracy • Enables fully-automated digital submissions through provider portals or service APIs, ensuring real-time decision-making and status updates

  3. Clinical Annotator Engine: • Converts medical notes into diagnosis and CPT codes, streamlining submission process • Determines the requirements of the PA system and generates Prior Auth requests

Solution Benefits: Brillio's Prior Authorization Solution delivers substantial cost reductions, elevates the quality of patient care, and alleviates administrative challenges bringing in patient focus to the healthcare system.

  1. Saves time and resources by eliminating manual filling of forms.
  2. Provides a simplified user experience for both payers and providers.
  3. Reduces denials improving overall productivity.
  4. Ensures compliance with service level agreements.
  5. Enhances provider experience and accelerates patient care.

Overview of assessment activities:

  1. Understanding the Client's Needs: • Initiate meetings with stakeholders to comprehend their pain points and desired outcomes. • Review any existing documentation, reports, or feedback to gauge prior concerns or issues.

  2. Assessment of Current Systems and Data: • Evaluate the existing software systems, infrastructure, and architecture. • Review the data structure, sources, quality, and utilization.

  3. Meet with the Technical Teams: • Engage with the IT and development teams to understand their perspectives on challenges. • Review their workflows, methodologies, and toolsets.

  4. Data Analysis and Interpretation: • Utilize the collected data to identify trends, anomalies, and areas that require attention. • Explore patterns in usage, user behaviour, or performance metrics.

  5. Documentation and Reporting: • Compile a detailed report outlining the discovered challenges, data insights, and proposed solutions. • Present this report to stakeholders, including actionable recommendations.

  6. Iterative Reviews and Feedback: • Maintain a communication channel for feedback during the assessment process. • Encourage stakeholders to provide insights and opinions for a comprehensive understanding.

This is all curated data. Precisely to showcase how we are masking the information before sending to OpenAI and it's clearly visible in the screenshots which shows the PII like Name that is getting masked.

Brillio's Azure Pre-Auth for Payers leverages Microsoft Azure to enhance the prior authorization process for healthcare payers. By utilizing Azure's robust cloud capabilities, Brillio's solution offers AI-driven automation and analytics, ensuring seamless adoption and scalability. Our professional services support clients from initial Azure setup to full integration, facilitating data migration, system compatibility, and continuous optimization. We ensure that our clients maximize their Azure investment, providing a tailored approach to extend Azure's utility with our specialized healthcare applications. This seamless integration with Azure not only streamlines operations but also unlocks new capabilities for data handling and compliance, positioning our clients at the forefront of healthcare innovation.