Electronic DME prior authorization is gaining popularity among payers. Initially, automation in many firms largely repeated the paper process, adding to duplicate data entry. However, considerable progress is being made toward a standards-based, real-time ability to electronically handle DME prior authorizations, as part of the electronic prescription process. Adoption is being accelerated by industry activities, provider pushback, and laws. Most folks are rekindling their enthusiasm in these hobbies, but many are unsure where to begin. In fact, at various stages of the electronic DME prior authorization evolution, the terrain is littered with plans. In actuality, there are early adopters, mature automated payers, and payers with varying levels of maturity depending on their area of business.
To be honest, not all of these adjustments are going as smoothly or as well as they could. The business is progressing quickly with new standards. The use cases emerging to address some of the sector's current difficulties, including pharmaceuticals that have been left out of the process, not to mention the growing impact of federal and state laws.

So, where should payers begin?

Here are some top features that payers should be aware of in order to successfully deploy electronic DME prior authorization. Payers must be aware of the following:

The meaning of prior authorization

Many people believe DME prior authorization is a one-size-fits-all activity. That has stymied development in the healthcare sector. In fact, prior authorization should be considered as a multi-transactional, evidence-based cost-cutting tool, rather than just increasing administrative stages, employing incentives, or combining the two. Progressive payers have made automating electronic DME prior authorization a top priority. Especially citing a variety of business and technology factors, lines of business, and customer-specific constraints. These complications must be factored into overall electronic DME prior authorization strategy. Not all electronic DME prior authorization is created equal, as successful initiatives realize.

The expenses of not putting electronic DME prior authorization

Payers face a multitude of costs while using manual PA. For starters, there are substantial administrative costs. According to research conducted by the Council for Affordable, Quality Healthcare (CAQH), each manual prior authorization for medical services costs plans $3.50 and providers $6.61. Payers will pay $2.80 for each transaction if they go electronic, while providers would pay $0.03. Overall, the study found that switching to electronic DME prior authorization may save providers $278 million per year and health plans $139 million per year.

Who is required to be on board?

Payers must determine which employees and vendors are required to participate in the electronic DME prior authorization transition. This may differ depending on the location and where the company is in the EHR acquisition/replacement cycle.
Payers have a hard time integrating electronic DME prior authorization into their internal systems, whether they're software or custom-built utilization management systems. Vendors have a wide range of skills, and there are hundreds to pick from.
Hence to summarize, electronic DME prior Authorization is a complex process and requires a lot of skill and knowledge to operate successfully. Hence, it’s imperative that the payers should know all the points and features mentioned above.