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New Tool Speeds Prior Authorization Time From Days to Seconds
Oct. 3, 2023
TULSA, Okla. — Blue Cross and Blue Shield of Oklahoma (BCBSOK) is responsibly integrating artificial and augmented intelligence to positively transform the prior authorization experience and expanding the scope of BlueApprovR℠, an intelligent solution built to streamline and accelerate the prior authorization (PA) process up to 1,400 times faster than current speeds.
“We believe prior authorization is an important way to ensure members receive access to appropriate medical care for their specific needs, while avoiding duplicative, unnecessary or wasteful services,” says BCBSOK Chief Medical Officer Todd Hoffman, M.D., CPE. “A few years ago, we started to look at how we could make it quicker and easier for providers and members to get the answers they need. BlueApprovR delivers those answers with results that we believe can positively transform the prior authorization experience for everyone involved.”
BlueApprovR was first developed in 2021, then piloted through specialty pharmacy and behavioral health in 2022. BCBSOK has expanded use of the tool to include inpatient acute care, long-term acute care, inpatient rehab, skilled nursing facility, outpatient hospice, inpatient hospice, home health, outpatient service and inpatient requests for prior authorization.
Smarter data in/quicker answers out
BCBSOK received at least 88,000 prior authorization requests in 2022.
BlueApprovR streamlines the prior authorization submission process and provides auto-approvals when critical criteria are met. By asking providers the precise number of questions required to evaluate and expedite claims, BlueApprovR helps ease the administrative burden on providers and their staffs — taking six minutes on average to submit a request.
Approvals are delivered nearly instantaneously, where it previously could take as many as 14 days. During the pilot, near-instant approvals were granted 80% of the time for behavioral health decisions and 66% for specialty pharmacy decisions.
By triaging and approving requests that require minimal information, the technology frees clinical staff to review more complex requests. No prior authorization requests are denied using the tool — they are only approved or advanced to a hands-on review by a BCBSOK clinician.
“So far it has been working well,” said Oakwood Springs Director of Utilization Review Christina Lawson. “We have become spoiled with the fast response time from portal submission.”
BlueApprovR is available for prior authorization requests for most members with group and individual and family coverage. In-network providers can access it via single sign-on through Availity®, on the Payer Spaces page.
AI solution
BlueApprovR is one piece of BCBSOK’s strategy to responsibly integrate artificial and augmented intelligence to improve the prior authorization process for members and providers.
BCBSOK has also evolved its artificial intelligence (AI) capabilities by designing proprietary algorithms that approve care for member treatments almost instantly. The algorithm references historical authorizations and claims, and recognizes what data is required to authorize treatment within seconds. As with BlueApprovR, all requests are reviewed with a human in the loop.
BCBSOK’s AI technology is used for 93% of BCBSOK members for a limited number of procedure codes. The company’s next phase will involve expanding the number of codes included.
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About Blue Cross and Blue Shield of Oklahoma
Blue Cross and Blue Shield of Oklahoma is the only statewide customer-owned health insurer in Oklahoma. We believe Oklahoma consumers and employers deserve the best of both worlds: access to affordable, quality health care and top-notch service from a company that focuses solely on customers, not shareholders. Customer value is our cornerstone. We are proud of the work we have done within our communities by helping to change the way we all live. Thanks to our more than 800,000 members, Blue Cross and Blue Shield of Oklahoma is able to focus on the health issues that impact our members as well as all Oklahomans.
Media Contact
Tricia Ament
918-551-2228
Tricia_Ament@bcbsok.com