Medical Management

IPD’s Prior Authorization application provides a complete solution for managing all phases of approving or denying Pharmacy authorization requests. Ultera® assists host systems in initiating new transactions from multiple input sources, including faxes and telephone-based requests. Once initiated, the application automates work assignments and priorities based on established business rules. The application’s workflow capabilities provide a familiar, status-based interface for automatically routing requests to the next step in the process, and eliminating duplicate requests. Together these features ensure that prior authorization requests are resolved within the shortest timeframe possible.

Many insurance carriers encounter challenges with Prior Authorization processes that impact efficiency and costs, including:

• Prescription needs are immediate and prior authorization requests must be handled very quickly
• Urgency often results in multiple submissions, resulting in a significant volume of duplicates
• Service Level Agreements (SLAs) with employer groups create contractually mandated response-time requirements
• Authorization requests are often received via fax resulting in the possibility of document loss or misrouting
• Manual routing makes understanding current status during follow up inquiries difficult

THE IPD SOLUTION

As an out-of-the-box application, Ultera® addresses these Prior Authorization challenges through the use of configurable modules that adapt to the company’s business needs.

IPD addresses the urgency in processing prior authorizations and cycle time performance by automatically identifying duplicate requests. This allows workers to focus on new requests eliminating the expense of addressing unnecessary work and improving processing speed.

Ultera® significantly reduces cycle times through real-time capabilities for receiving and presenting authorization requests, and managing work in process. During inquiries, status can be determined quickly resulting in increased customer satisfaction.

Efficiency and productivity improvements provided by Ultera’s® process management capabilities translate into measurable savings in staff costs and other factors relevant to prior authorization handling.

Ultera’s® data gathering and reporting capabilities provide significant, measurable cycle time and productivity improvements.