The Outlook on Electronic Prior Authorization, with special guest April Todd of CAQH

It’s no secret that achieving fully electronic prior authorization is a challenge, but the potential upside is tremendous—to the tune of $454 million in savings, according to the 2019 CAQH Index Report. On today’s show, Andrew Johnson meets with our special guest from CAQH, April Todd, to shed light on areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow, and efforts underway to speed adoption of electronic prior auth.

Today’s panelists are Andrew Johnson, vice president of Electronic Prior Authorization Solutions for Change Healthcare, and April Todd, senior vice president for the CAQH, a non-profit alliance creating shared initiatives to streamline the business of healthcare.

They unpack:

  • The purpose and role of the CAQH CORE (Committee on Operating Rules for Information Exchange)
  • Why prior authorization is a challenge for payers and providers
  • Update on alignment between industry standards bodies, including CAQH, WEDI, and HL7 Da Vinci
  • Which areas of healthcare are furthest along in adopting electronic prior authorization
  • CAQH’s latest research on the cost of manual versus automated transactions
  • How electronic prior authorization drives better patient care and reduces costs
  • Building blocks of an ideal prior authorization workflow
  • Steps Change Healthcare and CAQH are taking to advance electronic prior authorization
  • How COVID-19 is affecting adoption
  • Timeline for shifting prior authorization into a fully automated process
  • How listeners can support electronic prior authorization advancement

Episode Resources

  1. April Todd’s bio
  2. Andrew Johnson’s bio
  3. CAQH website
  4. CAQH Index
  5. CAQH Core
  6. The "Intelligent" 278: Creating a Standard for Shared Decision Support
  7. InterQual Connect
  8. How InterQual Connect works
  9. Automation and Appropriate Care
  10. Change Healthcare Industry Insights
  11. COVID-19 Updates and Resources
  12. COVID-19 Updates Newsletter
  13. Change Healthcare Insights Newsletter

Show Resources