Starting Independent prior Authorization service.. Feedback please

  1. I am in the process of starting a full service prior auth writing service.

    In the course of practice I have dealt with writing prior authorizations, mainly for medication. I know how they impact daily work flow and that sometimes because of the block of time required they often are set aside until that block of time appears. I have also begun to see a trend of simply switching to a less effective formulary option to save time.

    My motivation is improving patient outcomes by helping get them the meds they would benefit most from. So many patients don't even know this option exists.

    So my marketing proposal is to save prescribers/ prescriber staff valuable time that could be better used seeing patients. The second point is saving them money. Using an independent service as needed eliminates the need to increase staff to accommodate which includes the additional cost of paying benefits, paying social security, workers comp etc and training staff.. the provider can actually use the time to see more patients, increase billable hours ( Time spent writing PA's are not billable) vs using a service when you need them.

    By full service I mean, doing everything. Office contacts me, provides me name of patient, medication, pharmacy and payor. I then access record, research history and if necessary supplement justification with additional info found online, this is then presented to payor. Follow up as needed, provide additional info/ justification as needed. And when it's all done, notify provider. Allow me if they choose to adjust order if all that needs to be changed is dispense #or strength of medication as long as the order essentially is unchanged. Additionally if provider wants, contacting pharmacy and patient.

    So I could save them time and money and help them improve patient outcomes.
    i am right now HIPAA compliant, email, fax. Computer is secure, assessed and changes made for security of info by a cyber consultant.. so now... I am trying to figure out the best way to obtain clients. Obviously large clinics, healthcare systems are taken care of in house. So independent practices, smaller clinics.

    I think my hesitation right now is everything is theoretical.. I need a couple/few beta clients. Hands on see what remotely accessing records will entail.. once I get that,I am good to go.
    i am a CA. Licensed RN with over 20 years of experience, with very good research, writing and verbal skills.. and my driving goal is being an advocate for patients.

    After googling I have found similar services but none that are start to finish or independent. So I have to create from scratch.
    i would really appreciate any thoughts or feedback regarding this venture.

    Website should be live in about a week, advertising sources are being considered..Name of Service = PRN Rx Solutions.

    Am I crazy off base? Providers have said they would love such an option, but they aren't the decision makers.. I believe there's potential and I don't want to blow it. But I am at the proverbial fish or cut bait, step up to the plate, jump off the high board...
    thanks in advance...
  2. Poll: Are prior authorizations having an increasing impact on day to day workflow

    • Strongly agree

      100.00% 1
    • Somewhat agree

      0% 0
    • Neither agree or disagree

      0% 0
    • Somewhat disagree

      0% 0
    • Strongly disagree

      0% 0
    • Thoughts/comments:

      0% 0
    1 Votes / Multiple Choice
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    About 5150rn2

    Joined: Jul '16; Posts: 30; Likes: 38


  4. by   Ella26
    Sounds like a great service. How are things going?