Automated Prior Authorization

At Develop Health, we’re revolutionizing healthcare by streamlining processes. Our Automated Prior Authorization system stands as a testament to this commitment, offering both providers and developers a seamless, efficient method to handle prior authorization submissions. With capabilities on our user-friendly platform and robust API, we make prior authorizations simpler and more effective.

​

How It Works:

​

1. Determining the Need for Prior Authorization:

• Platform: By fetching the patient’s insurance card image directly from the EHR, our system quickly analyzes and determines if a prior authorization is necessary.

• API: Developers can use the API endpoint Medication Benefit Check to programmatically check the need for prior authorization based on patient details and prescription data.

​

2. Selecting, Autofilling, and Preparing Submission:

• Platform: Using the patient’s medical context, our platform auto-populates the relevant fields, selects the appropriate form, and prepares it for submission. Users can then review and finalize the submission.

• API: The all-in-one Prior Authorization endpoint facilitates the entire process for developers. From picking the right form, autofilling the necessary details to preparing it for submission – everything is handled efficiently. After the process, the endpoint returns a link for the user to review the answers and manually submit the prior authorization.

​

3. Submission:

• Platform: The platform provides a user-friendly interface to review the autofilled prior authorization form. After reviewing, users can easily submit the form to the appropriate PBM using the highest success channel, be it an automated phone call, fax, or ePA.

• API: While the Prior Authorization endpoint prepares the form, the manual review and submission ensure utmost accuracy and adherence to specific PBM requirements.

​

Benefits:

• Efficiency: Streamlined steps mean quicker prior authorization submissions without the typical hassle.

• Accuracy: With our AI-driven approach and data analytics, we ensure accurate form preparation, reducing the chances of denials.

• Flexibility: Catering to both healthcare providers on our platform and developers via our API, we’ve ensured that our automated prior authorization process meets diverse needs.

​

Conclusion:

Develop Health’s Automated Prior Authorization system represents our dedication to enhancing healthcare processes. By bridging the gap between our platform’s capabilities and our API’s robustness, we offer a solution that transforms the often tedious prior authorization process into a smooth, efficient task.