SOLUTIONS | AUTHORIZATIONS
Prevent Denials and Maximize Efficiency
Our Authorization management solutions optimize workflows, streamline authorization management, and prevent denials through data-driven automation and AI backed strategic interventions.
Authorizations are a hassle.
Approvals have to happen. Without them, denials occur, and reimbursement suffers. Retroactive approvals are possible, but we all know how challenging they can be. On top of that, the rules are constantly changing. Payers frequently modify their requirements, and no payer has the same requirements as another. All of this varies widely, adding complexity to an already complex system. Automating your authorization process and workflows can help overcome these challenges and protect your bottom line.
How We Do It
We leverage insights, identify opportunities in your system, and deliver high-quality results consistently to achieve success in your revenue cycle. We embrace continuous improvement using our revenue cycle expertise and AI and machine learning to stay agile and drive impactful growth for your health system.
We follow the data to automate & use AI to streamline your process.
SparkChange provides innovative authorization management through thorough, comprehensive analysis and tailored automations. We analyze your authorization denial patterns to identify key improvement areas and opportunities to automate processes. We investigate your denial patterns, build custom frameworks, reconcile service discrepancies, and monitor denials for appeals, ensuring smoother operations and costly time savings.
Optimize your workflows with automated actions.
Payer Requirement Framework
Using our data-driven methods, we develop a comprehensive framework that addresses your payer requirements. This framework ensures that all procedures and services are approved before they are performed. Based on scheduled services or orders placed, we identify scenarios that require approval. Our continuous improvement model continually analyzes and identifies other scenarios and updates your framework accordingly.
Authorization Required Automation
We provide an automated process for evaluating scheduled services against your custom framework to identify authorization requirements. This will also update the required authorization fields accordingly, eliminating the manual and cumbersome process of submitting and tracking the required authorizations for your staff.
Authorized vs. Performed Services Discrepancy
At times, a specific procedure or service is authorized, but the services performed may differ from the initially authorized procedures. SparkChange has created an automated process to detect discrepancies and initiate retro-authorization before billing, minimizing denials.
Missing Authorization Post-Service
When authorizations are submitted manually, tracking and obtaining the authorization numbers required on the claims can be difficult. We implement actions to prevent this from occurring and avoid those unnecessary denials. We don't just fix authorizations in the queue; we also fix historical denials. We've created an additional action that automates past denial appeals by attaching the authorization and queuing up for appeal to the payer.
Authorization Denial Automation Monitoring
Review CARC denials to see if authorization was required and obtained. We will trigger a work item to request an appeal if we determine it was obtained. If the denial did not require or have an authorization present, we will use these to build on the matrix for future authorizations required and can trigger a separate work item to have a user review.
Custom Edits
As a failsafe measure, we’ve created custom edits that are built in to ensure that any claim missing a required authorization is stopped before generating to prevent unnecessary denials.
Our Payer Requirement Framework Building Blocks
We begin by taking a comprehensive snapshot of your organization, then apply a continuous refinement approach to drive ongoing improvement. Leveraging machine learning and AI, our framework is constantly updated, creating a closed-loop process that continually enhances your authorization workflows and reduces denials.
Learn more about our machine learning, rules engine, and AI brain, SparkImedes.
ROOT CAUSE ANALYSIS
Volume of Denials
Volume by Payers
Encounter Types
Denied Charges
Missing Authorization
Impactful Resolutions
HISTORICAL AUTHORIZATIONS
To start, we do a 90 day historical review of your authorizations to establish a baseline for what authorizations are needed.
YOUR INTERNAL DOCUMENTS
We utilize your internal policies, procedures, and contracts to identify where authorizations are necessary to prevent denials. Our process eliminates the need for constantly updating internal spreadsheets and manual process and becomes fully automated in our Payer Requirement Framework.
Analytics
Spark360
Spark360 analytics leverage root cause analysis and historical authorizations to build a robust payer requirement framework, addressing denial volumes, payer trends, encounter types, denied charges, and impactful resolutions using your data.
Automations
SparkActions
Automate and optimize your workflows with SparkActions automations. We streamline your workflows by creating automated actions for authorizations, denial prevention, discrepancy detection, custom edits, and denial monitoring.
Services
SparkServices
With SparkServices, we use our revenue cycle expertise and your data to to create lasting results. We analyze denial patterns, create custom frameworks, reconcile service discrepancies, and help you monitor denials for swift appeals.
Contact Us to Learn More
Want to learn more about our authorizations solutions? We’d love to connect with you to discover how SparkChange can reinvent your revenue cycle process.