Welltok Modernizes Prior Authorization Process with Multi-Channel Approach

Personalized calls and text messages provide timely information required to schedule procedures or obtain medications

DENVER – August 26, 2020 – Obtaining prior authorization for prescription medications and procedures is often a burdensome and slow process, which is only exacerbated by COVID-19 and the current health crisis. A recent survey found 84% of providers reported the number of medical services that require prior authorization has increased, highlighting the need for an automated process. Welltok, the consumer activation solutions company, is helping modernize and improve the process by working with health plans, third party administrators (TPAs) and benefit managers to keep members informed and engaged in their health.

“It is essential for plan administrators to proactively communicate with individuals about where they are in the prior authorization process, in order to keep them informed and avoid costly care delays and a poor experience,” said April Gill, senior vice president solution management for Welltok. “Prior authorization has long been stuck in the land of fax machines. In a world where people get text message updates on everything from the status of online orders to hair appointment reminders, they expect the same for their health coverage. Moving to more timely, digital channels is an efficient and preferred way for consumers to keep informed of the process, not to mention it’s more cost effective.”

Most people do not understand prior authorization requirements and find it is challenging to stay on top of the process, which could lead to thousands of dollars out of pocket and increased medical costs in the long run. Welltok’s multi-channel communication capabilities, including automated voice (also known as IVR), email, direct mail and more, help providers and insurance plans efficiently keep consumers aware and informed of the prior authorization process. When people receive proactive status updates it improves communication and helps avoid potential disruptions in prescription regimes or delayed procedures.

Welltok is currently helping improve consumer touch points around the status of approvals, benefit coverage details (co-pay amount) and notifications of prior authorization routing. People may also receive information on how to appeal if there is a denial or get a warm transfer to a plan’s call center as needed.

Prior authorization is the evaluation of medical necessity and eligibility for coverage. It is the process by which a health plan determines if they will cover a physician-ordered prescription or non-emergency medical procedure. Prior authorization is also an important step in the healthcare journey for consumers as well as the revenue cycle for many health systems, especially for elective surgeries. While it is typically the physician’s responsibility to initiate prior authorization with a patient’s health plan, it is up to the individual to keep track of the process before completing a procedure or getting a prescription filled. This means health plans, or the external resource they use for processing prior authorization like a TPA, need to keep patients informed of approvals or rejections.

Welltok’s ability to contact members quickly with updates as well as provide details around outreach conducted for quality audit reviews can be of great benefit for plans. It not only meets the notification requirements defined by the Centers for Medicare and Medicaid Services (CMS), but also boosts member satisfaction and connectivity.

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Welltok is an award-winning consumer activation solutions company that improves people’s total wellbeing. Only Welltok leverages proprietary data and advanced analytics to engage consumers in personalized and rewarding ways to drive action. Our solutions integrate data-driven SaaS software, curated resources and professional services to help health plans, self-funded employers and health systems support healthier, happier populations.

Welltok is an equal opportunity employer.