Problem & Opportunity

As physicians, medical providers, patients and administrators know all too well, the current ordering, prior authorization and referral approaches are mostly manual, fragmented, inconsistent and cumbersome — creating wasted time and resources.

Anyone who has experienced the pain of medical order and service provision in managed healthcare or insurance programs understands the opportunities for task automation and process improvement at every level.

Common ‘prior authorization’ and referral requirements driven by insurers, clinical review companies and other third party agents are usually disruptive, non-transparent and expensive for physicians, rendering providers, patients and payers.

Current medical ‘necessity’ review and prior authorization systems lack the levels of automation, throughput, transparency, educative clinical reference or savings/ROI that an e-Ordering + CDS + Authorizing Platform provides.

Fortunately, health plans, Medicare and provider organizations are now adopting CDS tools for verification and pre-approval of diagnostic tests, and care coordination systems for utilization review, referral and benefit management.

Especially in the workers’ compensation, automobile and self-insurance sectors, approaches for managing utilization and medical provision costs are, when implemented, highly fragmented, manual, burdensome, expensive and, often, unnecessary. The added administration and delay involved with disparate workflows and systems for order requests, prior authorizations, referrals, reporting, notifications and claims adjudication negatively impact patient throughput and treatment times, data capture and exchange, payment accuracy and potential cost savings.

In many healthcare, insurance, medical provider and consumer segments there are no ‘universal’ ordering or referral systems that extend beyond ‘order entry’ points to integrate and align the full continuum of ordering-related events in managed care and payer programs, especially none that are driven by CDS and evidence-based guidelines. The multiple parties involved lack shared access to online software that would vastly improve the capture, verification, filtering, pre-approval and management of order data, related transactions and encounter costs.

Employers, payers, providers, managed care companies and patients all seek next level returns, which cloud-based IT solutions can deliver now — especially at the critical time– and point-of-order.

ProviderBASE℠ is a unique and innovative cloud-based Platform built to bring the entire process of medical services ordering, pre-approval, coordination, delivery, reporting and payment into one unified online resource hub.

With ProviderBASE℠, physicians, medical providers and care managers can quickly and correctly select the most relevant tests, procedures, medications and supplies based on symptoms, diseases, ICD9/10 codes and other data. Payers can set up rules to allow for automated ‘prior authorization’ and in-network provider referral processing based on the outcome of the CDS score plus other customized criteria and information.

Our proprietary approach with a tightly integrated Solution Set and Platform of e-Ordering + CDS + Authorization + Referrals to Provider Networks helps elevate the effectiveness, value proposition and returns of ‘utilization management’ and ‘cost containment vendor’ programs through improved penetration and reduced costs, burdens and delays. ProviderBASE is a timely ‘win-win-win’ for all patient care and insurance benefit stakeholders.