From Faxing to Automation: CareSource’s Journey to Streamline Inpatient Authorizations

The Ever-Full Fax Queue

While much of the rest of the world has moved on from fax machines, utilization management teams across the country still find themselves heavily reliant on this outdated technology. Among them until recently was CareSource, a 2-million-member health plan based out of Ohio. Their ever-full fax queue was the bane of their authorization process, driving hours and hours of extra work. They had tried to roll out portals, with some success here and there, however many of their providers continued to use fax.

Why did their providers prefer to keep on using fax? Because it involved fewer steps. The provider clinician working in the electronic health record (EHR) could simply hit a button to fax the authorization over without ever leaving their workflow. Therefore, in order to cut down faxes from those providers, it was clear to CareSource that the solution to this problem would have to be embedded within the providers’ workflow. In other words, it had to be bult into the EHR.

Automating Intake of Auths

CareSource turned to MCG Health. They had already found success partnering with MCG – the gold standard in evidence-based care guidelines and workflow solutions – on other UM processes. MCG is a thought leader and innovator in the field of automating authorization requests, and their Cite for Collaborative Care solution was precisely the tool that CareSource needed to break free of the fax queue.

To try out the new solution, CareSource identified two large providers who were still relying on fax submissions and, along with MCG experts, engaged them in a highly collaborative implementation project.

The EHR-embedded solution went live in October of last year and immediately began producing results. As hoped for, the volume of authorization requests received via fax decreased drastically.

Results of the New Solution

In the first 6 months, CareSource had over 4,500 initial authorizations bypass the fax queue and intake team entirely. Immediately, that was 6-7 minutes shaved off the intake process per authorization. That savings, however, merely scratched the surface.

In addition to the 4,500 initial authorizations, the system facilitated over 18,000 back-and-forth transactions – communications between the payer and provider to clarify the details of a given authorization. These too bypassed the payer’s intake team, again saving time on that step, as well as enabling overall faster authorization turnaround times. The ability to communicate back-and-forth within the EHR also eliminated the need for the providers’ intake teams to sift through faxes for the response from the payer, saving an additional 5-7 minutes on their end. Altogether, the solution averages a savings of 11-14 minutes per transaction for CareSource and their providers.

Synching up with their providers also improved their alignment in regard to medical necessity. University Hospitals – one of the two providers they worked with – reported a 82% reduction in denials achieved by using the platform.

Their automated workflow is still relatively new, and CareSource is still calculating the financial savings of this highly successful implementation. For now, however, they are seeing significant time savings, increased productivity, open bi-directional communications with providers, and improved satisfaction among users across the board.

Help from the Automation Experts

For other healthcare payers looking to reduce their fax queue and achieve similar workflow benefits, MCG can help. While no two authorization workflows are exactly alike, MCG’s Cite for Collaborative Care is customizable to meet payers where they are on the path to automation and take them to the next step – or beyond.

To learn more about automating authorizations with Cite for Collaborative Care, contact MCG Health here.

Image courtesy Shutterstock/Prostock-studio

The editorial staff had no role in this post's creation.