Prior Authorization Market Scan Report

Prior authorization (PA) is one of the most challenging aspects of ensuring prompt reimbursement and payment integrity for provider organizations. A patchwork set of state regulations compounded by the different requirements of payers, and the lack of a comprehensive electronic submission system leaves many providers unsure of when PA is required, completing the process manually, and struggling to commuicate with patients when and whether a procedure has been approved. 

Building on Chilmark's 2017 prior auth report, this report will look at the current state of regulations surrounding PA, how they are likely to evolve, and the costs and benefits of today's system. It will examine the technologies enabling new PA solutions such as APIs, NLP, and improved payer-provider convergence, as well as workflow solutions, the impact of claims analytics technology, emerging ePA solutions, and where the future of prior authorization lies.

Sample of vendors to be profiled: 4Medica, Accenture, athenahealth, Availity, Change Healthcare, Cerner, CenterX, Cognizant, CoverMyMeds, Epic, eviCore Healthcare, Klara, MCG Health, Optum, PriorAuthNow, Surescripts, Verata, Ziprad

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While you wait for this report, check out our other research on managing payment and financial risk: