How HIPAA compliant email streamlines the prior authorization process

The prior authorization process is used to control costs but often delays patient care due to extended time frames for communication. There are not many methods of communication available that offer both security and shortening this time frame for authorizations. HIPAA compliant email stands out as the best method of communication for healthcare organizations, perfectly fitting the bill for streamlining the authorization process.

What is the prior authorization process? 

The prior authorization process requires providers to submit detailed documentation to justify the medical necessity of any proposed treatments. Insurers then review these requests to determine whether to approve or deny coverage. While the process is useful to insurers, limiting payouts to what is necessary, often causes a delay in patient care that ranges from days to even weeks. 

A Journal of the American Academy of Dermatology study notes, "...PAs create a significant administrative burden for providers and practices," especially as the task of processing PAs may fall on both providers and support staff. This burden is exacerbated by the fact that "...administrative costs of PAs to medical practices and insurance companies are poorly documented." In critical cases where care becomes life or death, the interruption can result in patient conditions worsening. 

How email streamlines the authorization process

1. Instead of relying on slower methods like postal mail or phone calls, email can be sent instantly allowing for the quick submission of necessary documents and additional information. The speed is especially necessary in the prior authorization process where delays can have detrimental consequences. 
2. Email simplifies the prior authorization process by allowing providers to send digital copies of documents like test results and patient records directly to insurers or pharmacy benefit managers. Electronic submissions reduce the risk of errors or lost paperwork.
3. Using email reduces the need for physical mail reducing administrative costs related to paper, printing, postage, and manual document handling. The use of HIPAA compliant email platforms like Paubox reduces operational costs while offering unwavering security for the protected health information (PHI) transmitted.
4. Email systems act as centralized repositories that make it easier to track the status of requests and retrieve previously submitted information when needed. It also supports the requirements of the HIPAA Security Rule by providing a clear and organized audit trail of all prior authorization communications. 
5. Often the prior authorization process requires coordination between different specialists or departments. Using email allows providers from multiple professionals without delay. Information can easily be transmitted amongst various sources at the press of a button. 
6. Email also helps keep patients informed about the status of their treatment or medication requests. Providers can send updates directly to patients including information about what has been submitted and any delays in the process. 
   
   

FAQs

What is the difference between consent and authorization?

Consent is the patient’s agreement to share information for a specific, targeted purpose while authorization is formal permission for the disclosure of PHI under HIPAA. 

What is the function of audit trails in the Security Rule? 

Audit trails in the Security Rule track access to and activities involving electronic PHI to promote accountability in healthcare organizations and detect unauthorized access in their systems. 

How are insurers classified under HIPAA?

Insurers are considered health plans under HIPAA which entities that provide or pay for the cost of healthcare.