Prior authorization engine

The problem

Prior authorization work was split across systems. Clinical context lived in the EHR, medical requests went to payers through one portal and pharmacy requests went to PBMs through another. Staff had to move between all of them to get a single patient approved.

What we built

• A single work queue for medical and pharmacy prior authorization requests
• Clinical context pulled from athenahealth so staff do not re-key patient data
• Medical prior auth submitted to payers through Availity
• Pharmacy prior auth routed to PBMs from the same workflow