Experian Health, Inc.

Passport Health Communications, Inc.

Joseph M Magee, Iii

Edmond Chase Pilkington

Michael Moreau

Howard Bright

Lance Mansfield

Robert Bradley Mergner, Jr

Marcus Padgett

Amanda Barrett Long

Ramanujam Iyengar

Theresa W Marshall

Renee Rexrode Brehm

Shridar Vijay

Ciby Panicker Abraham

Anil George

Nikhil K Oza

Jack Bendon

Srinivasamurthy Chillara

Ramanan Thiagarajah

A preauthorization management system. The preauthorization management system allows a health care provider to submit a preauthorization request and track the status of the preauthorization request until a final determination is reached. Once a request has been submitted, the preauthorization management system monitors the status of the request until a final disposition is reached. The preauthorization management system documents the submission and determination process to provide a record that may be used to show an event or outcome occurred. The preauthorization management system offers a simplified and uniform system for managing preauthorization for health care services that reduces or eliminates the need for health care providers to learn diverse systems and procedures of a multitude of health insurance providers.

Preauthorization management system

An exception-based integrated patient access workflow via a single user interface is provided. When patient data associated with a healthcare encounter is received, various rules may be applied to cross-check the received data with other stored and received data to ensure correct patient data and to ensure accurate information for downstream patient access workflow processes. An indication of discrepant data, missing data, or input/user-interaction that may be needed for performance of a patient access workflow process may be provided. The indication may be provided via alerts displayed in an integrated user interface. Accordingly, a user may be able to address and resolve alerts to ensure patient access workflow processes are performed prior to a healthcare encounter.

Exception-based integrated patient access workflow

Account prioritization for a patient access workflow is provided. The patient access workflow may be an exception-based integrated workflow. An indication of discrepant data, missing data, or input/user-interaction that may be needed for performance of a patient access workflow process for a patient account may be provided via alerts displayed in an integrated user interface. A prioritization engine may determine a priority score for a patient account based on various determining factors and weightings applied to each determining factor. The patient account may be placed in a queue of accounts needing to be cleared in order by priority score, such that when a user selects to receive a next account to clear, the account with the highest priority score may be provided to the user. Accordingly, a user may be able to address and resolve alerts to ensure patient access workflow processes are performed prior to a healthcare encounter.

Account prioritization for patient access workflow

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Drexel Hill, PA, United States of America

Joseph M Magee, Iii