18 Best Prior Authorization Software In Healthcare for 2024
10 Best Prior Authorization Software Shortlist
Here's my pick of the 10 best software from the 18 tools reviewed.
Our one-on-one guidance will help you find the perfect fit.
In the complex world of healthcare, the need for efficient and effective prior authorization software is more critical than ever. That's where I step in. Prior authorization software is a powerful tool that automates and manages the process of obtaining approval from insurance companies before a service is provided. It cuts down on paperwork, reduces time spent on administrative tasks, and ultimately, increases your revenue.
Here's what it addresses: the tedious manual work of checking patient eligibility, ensuring policy compliance, outsourcing prior authorizations, submitting authorization requests, necessary APIs to integrate, tracking their status, and managing denials. These tools are aimed at eliminating these pains, freeing up your time to focus on what really matters: delivering exceptional patient care. So, let's delve into the specifics of each tool and find the best fit for you.
What Is a Prior Authorization Software?
Prior authorization software is a vital tool utilized by healthcare providers, administrators, and insurance companies to automate the process of securing approval for a particular service or medication before it's rendered. This preemptive verification helps ensure that the intended services align with the patient's insurance benefits and meet the payer rules medical necessity criteria.
Medical practitioners and administrative staff use this software to streamline administrative tasks, webinars, reduce manual errors, enhance compliance, and improve turnaround time for patient satisfaction by expediting their access to necessary treatments. Furthermore, prior authorization software aids in reducing instances of denied claims, thereby improving the overall revenue cycle management within a healthcare setting.
Best Prior Authorization Software Summary
| Tools | Price | |
|---|---|---|
| Change Healthcare | Pricing upon request | Website |
| PARx Solutions | Pricing upon request. | Website |
| DoseSpot | Pricing upon request. | Website |
| OptimizeRx | Pricing upon request. | Website |
| Infinx Healthcare | Pricing upon request. | Website |
| Azalea Health | From $210/user/month, (billed annually). | Website |
| CoverMyMeds | Pricing upon request. | Website |
| Myndshft | Pricing upon request. | Website |
| WAYSTAR | Pricing upon request. | Website |
| Advantasure | Pricing upon request. | Website |
Compare Software Specs Side by Side
Use our comparison chart to review and evaluate software specs side-by-side.
Compare SoftwareBest Prior Authorization Software Reviews
Change Healthcare is a comprehensive platform designed to streamline the revenue cycle, offering an efficient and effective way to handle the prior authorization process. Its financial clearance capabilities ensure insurance eligibility, validate medical necessity, and obtain all required authorizations, making it optimal for comprehensive financial clearance.
Why I Picked Change Healthcare: In my quest for the best prior authorization software, Change Healthcare stood out due to its comprehensive financial clearance capability. It addresses the multifaceted nature of prior authorization by not only securing approvals but also ensuring all financial aspects are cleared before service. This software is especially beneficial for providers wanting to reduce denials and increase upfront collections, justifying its spot as the best for comprehensive financial clearance.
Standout features & integrations:
Change Healthcare's standout features include real-time eligibility checking, financial clearance, and a robust claim referral management system. Its smart, automated system simplifies the process of securing approval and managing claims. As for integrations, Change Healthcare plays well with a wide range of EHR systems, offering seamless data exchange to enhance efficiency and accuracy.
Pros and cons
Pros:
- High compatibility with various EHR systems
- Robust claim management system
- Comprehensive financial clearance capability
Cons:
- Could be cost-prohibitive for smaller practices
- Quote-based pricing may not be transparent
- No free trial or version available
Best for facilitating smooth communication between providers and payers
PARx Solutions is a healthcare technology platform that provides a streamlined avenue for communication between healthcare providers and insurance payers. By doing so, it improves the efficiency and effectiveness of prior authorization processes, aligning well with needs of organizations seeking to enhance provider-payer communication.
Why I Picked PARx Solutions: I picked PARx Solutions for this list due to its strong focus on improving communication channels between providers and payers. This focus, though seemingly simple, plays a significant role in overcoming one of the major bottlenecks in the prior authorization process. In this respect, it stands out from many other tools in the market. This commitment to facilitating smoother communication made it my top choice for organizations that grapple with provider-payer communication challenges.
Standout features & integrations:
PARx Solutions boasts features like its PASSTM (Prior Authorization Support System), which helps streamline the submission of prior authorization requests. It also provides tools to track the status of these requests in real-time. Regarding integrations, specific information is not provided on their website, suggesting that the platform may be customized based on the individual needs of their clients.
Pros and cons
Pros:
- Offers real-time tracking of request status
- Streamlines the submission of prior authorization requests
- Facilitates smooth communication between providers and payers
Cons:
- Lack of public information about integrations
- Pricing information not transparent
- No clear information on a free tier or trial
DoseSpot is a healthcare software designed to integrate electronic prescribing (e-Prescribing) with the process of prior authorization. This integration makes it a valuable tool for healthcare organizations looking to blend the benefits of e-Prescribing with the necessity of prior authorizations.
Why I Picked DoseSpot: I chose DoseSpot for its unique proposition of integrating e-Prescribing into the prior authorization process. Unlike many other solutions, DoseSpot leverages the benefits of digital prescriptions to streamline authorizations, making it distinctively efficient. Thus, for any organization keen on capitalizing on the intersection of e-Prescribing and prior authorizations, DoseSpot is an excellent choice.
Standout features & integrations:
DoseSpot provides a comprehensive suite of e-Prescribing features that seamlessly incorporate into the prior authorization process. Furthermore, the platform supports integrations with a wide range of Electronic Health Record (EHR) systems, expanding its usability and ensuring its fit within diverse healthcare IT ecosystems.
Pros and cons
Pros:
- Designed for a diverse healthcare IT ecosystem
- Supports a wide range of EHR integrations
- Integrated e-Prescribing and prior authorization capabilities
Cons:
- Potential learning curve for users unfamiliar with e-Prescribing systems
- Pricing information not transparent
- No visible free tier or trial offerings
OptimizeRx is a pioneering digital health platform that blends real-time notification for healthcare messages at the point of care, effectively connecting the pharmaceutical industry and patients. It has made a name for itself by focusing on patient affordability, a major concern in prescription drugs.
Why I Picked OptimizeRx: I chose OptimizeRx for its unique commitment to patient affordability in the realm of prescriptions. This platform stands out because it bridges the gap between pharmaceutical companies and patients, integrating affordability seamlessly into the process. For those looking to manage and even reduce prescription costs, OptimizeRx is a superb choice.
Standout features & integrations:
OptimizeRx offers features like real-time healthcare messaging, patient engagement, and assistance programs to help patients afford their prescriptions. Moreover, it boasts an impressive list of integrations with electronic health record systems (EHRs), providing users with a wealth of crucial patient data at their fingertips.
Pros and cons
Pros:
- Extensive integrations with EHR systems
- Real-time healthcare messaging enhances communication
- Puts patient affordability at the forefront
Cons:
- The interface might be overwhelming for some users
- Pricing is not transparent
- No free plan available
Infinx Healthcare is an innovative solution that leverages artificial intelligence and predictive analytics in the realm of prior authorization. With its cutting-edge technology, it streamlines the prior authorization workflow, ensuring speed and efficiency.
Why I Picked Infinx Healthcare: Infinx Healthcare grabbed my attention with its impressive use of AI and predictive analytics, a stand-out feature in the landscape of prior authorization tools. This cutting-edge technology not only speeds up the workflow but also anticipates and resolves potential issues before they arise, making it an optimal choice for those seeking efficiency through technology in their prior authorization process.
Standout features & integrations:
Infinx shines with its AI-driven workflow and predictive analytics capabilities that can flag potential authorization issues in real-time, enabling proactive issue resolution. It integrates well with various EHRs and EMRs, further enhancing the user experience and promoting seamless data exchange.
Pros and cons
Pros:
- Proactive issue detection and resolution
- Integrates with various EHRs and EMRs
- Use of AI and predictive analytics for faster workflow
Cons:
- A learning curve may be required to fully leverage AI features
- Pricing details are not transparent
- No free tier or trial available
Azalea Health offers an integrated system of healthcare solutions aimed at optimizing the patient experience and streamlining administrative workflows. It particularly shines in facilitating interoperability, a feature that makes it an ideal choice for rural hospitals seeking to connect disparate systems.
Why I Picked Azalea Health: I chose Azalea Health for its focus on interoperability, a crucial factor often overlooked in rural healthcare settings. This platform bridges the gap, offering a solution that connects diverse health information systems. Its commitment to enhance accessibility and communication across rural hospitals sets it apart. This makes Azalea Health the go-to choice for rural hospitals seeking interoperability.
Standout features & integrations:
Azalea Health brings to the table a combination of electronic health records (EHR), practice management, and revenue cycle management. Its telehealth capabilities are also noteworthy, ensuring uninterrupted patient care regardless of geographical limitations. Azalea Health integrates seamlessly with laboratories, pharmacies, radiology centers, and more, contributing to a well-connected healthcare network.
Pros and cons
Pros:
- Comprehensive suite of services including EHR, practice management, and revenue cycle management
- Offers telehealth capabilities
- Prioritizes interoperability, enhancing communication across different systems
Cons:
- May not be suitable for smaller practices due to its extensive features and corresponding price point
- Pricing isn't transparent due to quote-based system
- No free version or trial
Best for seamless network-wide coverage for medical and pharmacy benefits
CoverMyMeds is a healthcare solution focused on streamlining the process of medical and pharmacy benefits across a network. By offering comprehensive network-wide coverage, it facilitates the smooth and efficient operation of medical and pharmacy benefits.
Why I Picked CoverMyMeds: I picked CoverMyMeds because it offers an effective solution for handling network-wide medical and pharmacy benefits, distinguishing itself in the healthcare tech landscape. Its comprehensive coverage of both medical and pharmacy benefits stands out among other tools, making it the top choice for healthcare providers and organizations seeking to optimize these specific processes.
Standout features & integrations:
CoverMyMeds offers a host of features including ePA services, network-wide medical and pharmacy benefit coverage, and patient assistance programs. For integrations, CoverMyMeds can seamlessly connect with many pharmacy systems and Electronic Health Record (EHR) vendors, which enhances its overall utility.
Pros and cons
Pros:
- Wide range of pharmacy system and EHR integrations
- Free ePA services for prescribers and pharmacists
- Comprehensive coverage of medical and pharmacy benefits
Cons:
- Learning curve for users unfamiliar with healthcare network management systems
- Additional features may require payment
- Pricing information is not transparent
Myndshft is a provider of software that leverages artificial intelligence (AI) and blockchain technologies to streamline healthcare management. It primarily aids in automating administrative tasks, thus enhancing efficiency and accuracy in healthcare operations. Given its specific focus on cognitive blockchain technologies, Myndshft excels in managing healthcare procedures securely and transparently.
Why I Picked Myndshft: In choosing tools for this list, I found Myndshft's application of cognitive blockchain technologies in healthcare management to be truly distinct. Its combination of AI with blockchain gives it an edge, allowing it to bring unmatched security and transparency to healthcare operations. Therefore, it stands out as the best tool for those seeking to leverage blockchain technology in healthcare management.
Standout features & integrations:
Myndshft's key features include its intelligent process automation, which blends cognitive computing and blockchain technology. This not only aids in automating complex tasks but also ensures data integrity, security, and transparency. Regarding integrations, while specific ones are not detailed on their website, Myndshft's technology is designed to mesh with existing healthcare systems.
Pros and cons
Pros:
- Ensures data integrity and transparency
- Enables automation of complex tasks, enhancing efficiency
- Combines AI and blockchain for secure and efficient healthcare management
Cons:
- Limited information on specific integrations
- No free trial or version is available, which might deter first-time users
- Pricing information is not publicly available
Waystar is a cloud-based healthcare revenue cycle management platform that helps healthcare organizations streamline administrative tasks and optimize financial outcomes. The solution simplifies and unifies the healthcare revenue cycle through automated workflows, improved patient collections, and predictive analytics.
Why I Picked Waystar: In the selection process, I found Waystar to be particularly effective in its capacity to enhance collections and lighten administrative loads. Its AI-driven features offer efficient end-to-end automation, minimizing the need for manual input. Consequently, I consider it best suited for healthcare organizations seeking to maximize collections while reducing claim denials and their administrative workload.
Standout features & integrations:
One key feature of Waystar is its advanced predictive analytics, which assists healthcare providers in identifying and addressing financial challenges. Another notable feature is its patient financial engagement tool that improves collection rates. Waystar integrates with several popular EHR platforms, including Epic, Cerner, and Allscripts, facilitating seamless data transfer.
Pros and cons
Pros:
- Seamless integration with popular EHR platforms
- Advanced predictive analytics help address financial challenges
- Automated workflows reduce administrative tasks
Cons:
- Some users might find the platform complex to navigate initially
- Absence of a free version or trial period
- No publicly available pricing details
Advantasure is a technology-driven health solution that aids healthcare organizations in managing population health. It delivers advanced analytical insights, scalable healthcare management solutions, and flexible business process services, allowing for proactive care management and risk adjustment.
Why I Picked Advantasure: After evaluating multiple tools, I chose Advantasure for its robust capabilities in managing population health. What sets it apart is its focus on risk adjustment and its ability to deliver insights at a population level, which can significantly improve health outcomes. Given these strengths, Advantasure is ideal for healthcare organizations that aim to manage health on a population scale.
Standout features & integrations:
Notable features of Advantasure include its comprehensive population health management solutions, risk adjustment services, and healthcare analytics. Its platform's powerful analytics engine can derive meaningful insights from complex health data, making it invaluable for managing health on a large scale. Although specific integrations aren't listed on their website, their solutions are designed to easily integrate with existing healthcare systems.
Pros and cons
Pros:
- Designed for seamless integration with existing systems
- Powerful analytics engine capable of deriving insights from complex data
- Robust capabilities in managing health on a population scale
Cons:
- The platform may seem complex for beginners
- No information available about a free version or trial period
- Pricing details are not publicly available
Other Healthcare Prior Authorization Software
Below is a list of additional prior authorization software that I shortlisted, but did not make it to the top 10. Definitely worth checking them out.
- AccuReg
Best for comprehensive revenue cycle management
- Surescripts
Best for streamlined, real-time decisions at point-of-care
- HealthTrio
Good for secure and scalable health information exchange
- NextGen Healthcare Prior Authorization Management
Good for efficient management of prior authorizations in healthcare
- Cloudmed
Good for revenue intelligence in healthcare institutions
- Inmediata
Good for comprehensive health information management and data exchange
- Glidian
Good for simplifying prior authorization in healthcare practices
- Experian Prior Authorization
Good for streamlining patient access and registration processes
Other Popular Medical Software Lists
Here are some other popular software solutions for a modern medical practice.
Selection Criteria For Prior Authorization Software
For this article, I learned about the types of billing solutions for healthcare that streamline the prior authorization process. I evaluated dozens of these tools, and my main focus was on the tools' ability to streamline and simplify the prior authorization process in healthcare, which I'll go into more detail about below.
Core Functionality
- Efficiently submit, track, and manage prior authorization requests
- Automate repetitive tasks related to the prior authorization process
- Enable seamless exchange of health information between providers and payers
- Support compliance with healthcare regulations and standards
- Facilitate real-time updates and alerts on the status of prior authorization requests
Key Features
- Integration Capabilities: The tool should be able to integrate with existing EHR/EMR systems for seamless data exchange.
- Compliance Management: The tool should have features that support compliance with healthcare regulations such as HIPAA and HITECH.
- Real-Time Tracking: The tool should allow users to track the status of authorization requests in real-time.
- Integration with medical billing codes: The tool should enable the connection of tasks to billable hours using the standard coding process.
- Automation: The tool should automate repetitive tasks such as form filling, data entry, and tracking.
- Reporting and Analytics: The tool should provide insights into the prior authorization process to help identify bottlenecks and improve efficiency.
Usability
- User Interface: A good tool should have a clean, intuitive interface that makes navigation and performing tasks simple. It should be able to display complex data in an easy-to-understand format.
- Ease of Onboarding: The tool should have resources like tutorials, guides, and support to help users understand and navigate the software effectively.
- Customer Support: The tool should provide prompt and effective customer support to address any issues users may face.
- Role-Based Access: Given the sensitivity of health information, the tool needs to have configurable role-based access controls for data security.
I suggest staying ahead with medical billing and coding courses that address the complexities of prior authorization processes to improve approval rates.
Most Common Questions Regarding Healthcare Prior Authorization Software (FAQ's)
What are the benefits of using prior authorization software?
Utilizing prior authorization software offers numerous benefits including increased efficiency by automating routine tasks, improved accuracy by reducing manual errors, enhanced compliance with healthcare regulations, real-time tracking and status updates of authorization requests, and better decision-making through comprehensive reporting and analytics.
The right healthcare billing professional can make prior authorization software integration smooth and hassle-free.
How much does prior authorization software typically cost?
The cost of prior authorization software varies widely based on the features, number of users, and the size of the organization. Pricing may be subscription-based, usage-based, or one-time license fees.
How much to charge as a medical billing specialist?
Depending on your experience and location, a medical billing specialist might charge anywhere from $16 to $35 per hour. As you gain more certifications and expertise, you can adjust your rate accordingly. Find out more about pricing in this medical billing salary breakdown.
What is the typical range of pricing for prior authorization software?
The pricing for prior authorization software can range from as low as $10 per user per month to over $500 for more advanced, enterprise-grade solutions. It’s important to consider the specific needs and budget of your organization when selecting a software.
What is the cheapest prior authorization software?
The cheapest prior authorization software would be those that offer a free tier or low-cost options. Tools like Glidian offer affordable solutions that start at around $10 per user per month.
What is the most expensive prior authorization software?
The most expensive prior authorization software is typically enterprise-level solutions with extensive features and customization options. Tools like Cloudmed can reach up to $500 or more per user per month.
Are there any free prior authorization software options?
While most prior authorization software comes with a cost, there are a few providers who offer a free version or trial of their software. However, these are typically limited in terms of features and functionality. Always confirm the specifics with the provider before making a decision.
What are medical billing services?
Medical billing services provide essential support to healthcare organizations by managing the entire process of billing and claims submission. These services cover everything from medical coding and charge entry to claim submission, payment posting, and denial follow-up, ensuring that healthcare providers receive full compensation for their services. Outsourcing medical billing helps reduce errors, improve compliance, and enhance revenue cycle efficiency, freeing up healthcare staff to concentrate on patient care rather than administrative burdens.
What is medical billing and coding?
Medical billing and coding is the process of assigning codes to medical treatments and procedures. Coders take medical records and apply codes, while billers use those codes to submit payment requests to insurance companies or patients.
What are medical billing and coding deadlines by state?
Medical billing deadlines vary by state and insurer, with most falling between 30 and 90 days after services are rendered. Healthcare providers must check local regulations and contracts to ensure accurate, timely claims.
Other Medical Payment Tools
Here are some other payment tools, systems, and services that might interest you.
Summary
I suggest you begin with an explanation of medical billing to help you select the best prior authorization tools.
Choosing the right prior authorization solution software depends largely on the specific needs of your healthcare organization. The software should streamline and automate the process of submitting, tracking, and managing pre-authorization requests, thus reducing manual errors and increasing efficiency.
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