Kathleen Lokay: Clinical Pathways Can Prevent Prior Authorization Delays
Clinical pathways can help providers avoid delays with prior authorization by ensuring that all the necessary information is there, explained Kathleen Lokay, president and CEO of Via Oncology.
Transcript How can pathways programs assist physicians who face prior authorization delays?
The challenge with prior authorization is the idea that oftentimes what your picking for the patient might be the right thing, but it’s all the information that has to be provided that is necessary to get it paid for. So, it’s rarely that the treatment itself is not eligible for prior authorization, but that the information is lacking.
One of the way we try to support folks with clinical pathways is by providing all that clinical information to the staff who actually seek the prior authorization. By getting the right information into the prior authorization into the portal the first time, then the likelihood of getting the prior authorization and having it go through successfully initially is much higher as opposed to finding out a week or a month or 6 months later that you didn’t give all the information and therefore your prior authorization didn’t go through and you’ve got a denial on your hands.
So that’s one of the key ways we see decision support really helping with prior authorization is by providing that critical clinical data.