TransUnion Healthcare Speeds up Prior Authorization Process, Reducing Provider Administrative Costs.  Company also enhances Insurance Eligibility solution to integrate directly with market leading Electronic Health Records (EHRs)

To help further improve the patient experience at hospitals and health systems, TransUnion Healthcare (NYSE:TRU) today announced the expansion of its Patient Access solution suite with the launch of its Prior Authorization solution and the enhancement of its Insurance Eligibility offering.

TransUnion’s Prior Authorization solution helps ensure providers will be reimbursed for the patient care services they provide. The company’s Insurance Eligibility solution has been enhanced to help streamline front-end workflows by integrating directly into hospital electronic health records (EHRs). Together, the solutions will help improve overall revenue cycle efficiency.

TransUnion is leveraging its market leading Insurance Eligibility Clearinghouse, which currently processes millions of transactions daily and is primarily delivered to ambulatory providers via channel partners, to expand its offerings to hospital providers. The offerings will be featured at the National Association of Healthcare Access Management (NAHAM) Annual Conference.

Streamlining and standardizing the prior authorization process

TransUnion Healthcare’s Prior Authorization solution allows providers to confirm if an authorization is required for medical procedures prior to service. This upfront screening helps providers reduce downstream rework, lower administrative costs and prevent denials that can result from missing prior authorizations.

Registration staff have access to TransUnion’s Prior Auth Library℠, which contains more than 1.5 million payer-specific prior authorization rules for more than 16,000 procedure codes covering 92% of U.S. insured lives.

The solution delivers:

  • A single rules library that combines payer-published rules and the provider’s authorization rules, providing central access to the right rules at the right time, all in one place;
  • Easy online access to the most up-to-date prior authorization requirements across payers;
  • Immediate response as to whether an authorization is required for a specific procedure, enabling fast decision-making;
  • Seamless integration with TransUnion Healthcare’s ClearIQ solution, simplifying workflows with task-driven, exception-based work queues;
  • Integration to third-party patient access solutions and EHRs via application programming interfaces (APIs)

Hospitals secure more accurate eligibility and benefit information upfront

TransUnion’s Insurance Eligibility solution allows hospitals to verify patient coverage, including copays, coinsurance, and deductible information.

The solution delivers:

  • Connectivity to more than 800 payers, covering 98% of U.S. insured lives;
  • Multiple delivery options for eligibility information, including integration with Epic and MEDITECH patient registration systems and batch transactions, to meet hospitals’ different needs;
  • Optimized 271 eligibility responses that display eligibility data in an easy-to-read summary, helping hospital staff quickly find and interpret key eligibility information;
  • Intelligent recursive search that automatically runs multiple queries to find the best payer response

The expansion of Insurance Eligibility and the addition of Prior Authorization round out TransUnion’s Patient Access solution suite to both hospital and ambulatory providers, which includes Identity Verification, Medical Necessity, Patient Payment Estimation, Financial Aid, Propensity to Pay, and Charity Assessment. The easy-to-use solutions let staff engage patients early—and target point-of-service collection.

Source: TransUnion Press Release