Healthcare Payer
Prior Authorization Modernization
Sample case study — illustrative of the S & Co. methodology pending approved client content.
Challenge
Manual prior authorization intake and review created long turnaround times, provider friction, and limited visibility into where requests were stalling.
Approach
We mapped the end-to-end authorization journey, quantified touch points and rework, and prioritized automation opportunities against regulatory requirements.
Solution
A redesigned intake-to-decision workflow with electronic submission, rules-based routing, standard work for reviewers, and an operational dashboard for daily management.
Impact
Faster decisions for members and providers, with a scalable model ready for evolving interoperability mandates.
Results
- Substantially reduced average turnaround time
- Fewer manual touches per request
- Real-time visibility into queue and aging
Capabilities Used
- Operations & Process Improvement
- Program & Project Management
- Technology Consulting