Case Study: Prior Authorization Automation & EMR Integration

About The Project

We were approached by the owner of a digital health startup who wanted to design a product to improve and streamline the process for a doctor’s office to obtain prior authorizations (PA) from the insurance companies. As a startup they did not have any software yet but several Rheumatology clinics ready to pilot the service.

This project had to come together on very short notice and required a team that was capable of hitting the ground running and delivering quickly yet effectively. We assembled a full stack development team of programmers and quality specialists who had built similar PA systems in the past. The project also required integration with the doctor’s EMR system, and their first pilot customer used Aprima. We included subject matter experts who had years of experience integrating with various EMR systems, and one of our experienced project managers who had worked with EMR vendors and integration vendors.

The project included a web application as a portal for the clinical team and customers to work on PA requests and review their status. The application had several integrations with health plans for submitting PA requests automatically, and a fax vendor to electronically send and receive forms and communications with the Insurance Companies.

We transitioned our support and the application maintenance to their in-house team over time, and the lessons we taught them set them up for future successes as they integrated with other EMR vendors.

We managed the relationship between our client, who was new in the technology space, the IT and network security team at their doctor’s office and the EMR Vendor. Our extensive experience working with FHIR and HL7 transaction sets and our history working with EMR Vendors helped accelerate the timeline dramatically, and ensure an efficient and successful implementation that saved everyone time and resources.

 

Result/Outcome

We worked with our client through their design and implementation phase, and consulted them through their successful integration with their pilot client’s EMR vendor Aprima. The built an enterprise grade software application that successfully launched their pilot and several subsequent clients.

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