Best Prior Authorization Software in the USA

ScriptSure Cloud ERX is the #1 E-Prescribing application available. ScriptSure combines weekly updates to medications, daily updates to pharmacy lists, full e-prescribing network connectivity, Electronic Prescribing of Controlled Substances (EPCS), web-based access and simple workflow methods to deliver the best in E-Prescribing. Electronic refills, order sets, compound medication order, printing prescriptions, patient reports and audit logs are all included and supported in ScriptSure Cloud ERX. ScriptSure is fully HIPAA compliant. ScriptSure Cloud ERX is the winner of the 2021, 2022 & 2023 Surescripts network White Coat Award for Most Accurate Prescriptions and a total 11-time award winner of this prestigious award.

Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status online, and receive remittance advice. Accepting standard ANSI formats, data entry, and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.

EHR 24/7 by Office Ally empowers more than 20,000 users with efficient patient care management. It has charting, real-time data, customizable forms, and integrations for patient intake and e-prescription solutions. With no implementation needed, healthcare providers can use EHR 24/7 to treat and document patients today.

RXNT's cloud-based integrated Electronic Health Records (EHR), software with E-Prescribing and Patient Portal optimizes patient treatment and streamlines workflows in practices of all sizes and specialties. Providers have access to the most current patient health information and prescription history from one database, accessible from any device. Integrated communications allows providers to share real-time clinical information with patients and clinicians, allowing for better care coordination. The use of "smart keys" and intake forms allows for customization and eliminates redundancy. Your practice will enjoy the Patient Check-In feature and integrated Electronic Prescribing. HIPAA compliant, ONC certified, EPCS-certified and meets MACRA/MIPS requirements. RXNT also offers Practice Management (PM), which includes Medical Billing, Scheduling, and standalone E-Prescribing. You can choose a solution by the piece with predictable pricing or you can implement our Full Suite for one, integrated platform.

You can save time by using templates and patient charts in the cloud-based EHR. These templates can be customized to meet your specific needs. Browse through a collection of medical charting templates created by practices like yours. Manage prescriptions, including controlled substances and those that require prior authorization, efficiently. You can easily exchange information with local pharmacies and laboratories, imaging centres, and other tools integrated into EHR platform. You can choose from over 500 imaging and lab centers to order tests and share the results with patients. Flexible billing options with industry-leading partner companies that help you get paid quicker. You can monitor your progress using insightful dashboards. You can also submit data directly to CMS through your EHR. Access customizable dashboards that allow you to track your progress in quality initiatives such as MIPS. To navigate the complexities and complexities of quality measures, you can find extensive education and training resources.

Waystar offers market-leading technology that streamlines and unifies revenue cycle. Their cloud-based platform streamlines workflows, improves financials for all healthcare providers and provides more transparency to the patient's financial experience. Waystar has been ranked best in KLAS for Claims & Clearinghouse every year since 2010. It has also received #1 rankings in Black Book™, surveys since 2012, and the Frost & Sullivan North America Customer Valu Leadership Award for ambulatory RCM service in 2019. Waystar is used by over 450,000 providers, 750 hospitals and 5,000 plans. It integrates with all major HIS/PM systems. Waystar.com and @waystar on Twitter provide more information.

Practice Mate by Office Ally is a comprehensive HIPAA-compliant practice management solution used by over 25,000 healthcare organizations. Its user-friendly interface simplifies revenue cycle and billing management and streamlines booking to increase administrative workflow efficiency. It seamlessly integrates with other Office Ally solutions to provide patient intake, reminders, and e-prescriptions. You can get started today at no cost, commitment, or implementation to reduce administrative tasks, enhance job satisfaction, and improve the overall patient experience.

Azalea is a leader in interoperable cloud-based healthcare services and solutions. Azalea's platform offers electronic health records with integrated telehealth functionality, revenue cycle management, and analytic software. Azalea's integrated platform is focused on customer success and can be used by all practices and hospitals ambulatory strategies. It instantly improves cash flow and clinical outcomes through care coordination innovation and revenue cycle performance.

Providers can lose thousands to millions of dollars each year due to medical necessity denials. This is in addition to the time and effort required to appeal denials and respond to patient concerns. Payers face the same problem at the other end of claim management. They have to pay for unnecessary medical procedures and treatments, as well as the time spent on denial appeals. This increases costs but doesn't improve outcomes. Patients can also be subject to unnecessary copays or other out-of pocket costs. This can lead to poor patient experiences and costly care that they don't need. ABN Assistant™, a Valenz®, Assurance product, provides the prior authorization tools providers require to validate medical necessity, create Medicare-compliant ABNs and estimate cost. This allows them to stop more than 90 percent of medical necessity denies by verifying that the patient is in need of the care.

MedicsRIS, a radiology information system, allows radiologists to easily manage their practice and get paid for all diagnostic exams. MedicsRIS was developed by Advanced Data Systems. It accepts inbound orders from a referring physician's stage 2-certified electronic medical record (EMR). This allows the doctor to avoid costly HL7 interfaces and also gives incentives and avoids penalties. MedicsRIS' core features help increase business productivity. They include a referring physician portal, automated billing with EDI and multi-modality scheduling. Insurance eligibility verification is also included.

We are accelerating the development of innovative solutions to benefit all healthcare stakeholders. This will help to increase access to therapy, decrease prescription abandonment, and improve patient outcomes. We are committed to removing healthcare access barriers, whether that's by resolving prior authorization issues or increasing awareness about support services. Healthcare is becoming more expensive than ever. Assist your patients with their prescribed therapy by finding affordable solutions that will help them with high-deductible plans, increased copays, and lack of visibility. Some patients find that staying on their therapy is the most difficult part of their healthcare journey. This could be because they don't know how to take their medication or remember to do it at the right time. These adherence challenges should be addressed with people-first solutions.

MDToolbox-Rx, a Certified, Award-Winning electronic prescription writer, can be used standalone or in conjunction with other office software. The e–Prescribing Software allows you to quickly and easily select drugs, find information about them, and create and send a prescription electronically. MDToolbox-Rx has been certified for e-Prescribing and Eligibility, Formulary (e-Prescribing Controlled Substances), as well as Electronic Prior Authorization. The largest drug database allows you to search for drugs by name, nicknames, generic, brand rx, OTC, or class. Lower pharmacy calls and less time spent on renewal requests lead to higher productivity.

PracticeAdmin Scheduling helps reduce no-shows, improves patient interactions, and provides the data you need on a timely basis. Our proprietary rules-based architecture allows you to set your preferences, whether you are a single provider, small or medium-sized provider, or a provider with multiple locations. You can create your own scheduling templates and set up automated reminders for patients. Billing is your single-stop tool to manage patient registrations, claims, and payments. You can keep track of all your patient information and authorizations. It can be integrated with your EHR and helps you keep track of your Meaningful use certification. Billing allows you to see if your claim is incorrect before it is sent. You can quickly resubmit your claim without penalty and keep track of all EDI rejections.

Benchmark PM transforms patient engagement, covering everything from initial intake to final encounter. Key features include streamlined patient onboarding, hassle-free appointment scheduling, customizable reminders, comprehensive reporting, and user-friendly dashboards. On the billing side, Benchmark PM offers integrated claims management, a connected clearinghouse, electronic billing, insurance verification, and a versatile payment portal, simplifying the entire process. Benchmark Solutions provides a complete management solution for healthcare practices with Benchmark EHR software, Benchmark PM software, and Benchmark RCM services. This robust electronic toolset streamlines daily operations, boosts revenue, and enhances the patient experience. Each component of the Benchmark Solutions' suite is modular, ensuring easy integration with your existing systems. With Benchmark Solutions, you can focus on delivering high-quality care while we take care of the operational and administrative aspects, ensuring your practice runs smoothly and efficiently.

Logix runs in the background and completes tedious but important workflow tasks such as refill requests, prior authorizations refill too soons, refill too quicklys, fax escalates, and documentation for phone calls. Other tasks like email and fax can also be automated. You can also reduce human error in repetitive tasks. You can also create notifications to ensure you don't forget anything and allow you to redirect your time to better serve patients. Every click and keystroke counts! Logix processes can be used to reduce document handling and processing times by an average 1-4 minutes per document. Logix can be used with DocuTrack to help reduce keystrokes and improve efficiency for your pharmacy staff. For some processes, you can reduce the number of keystrokes required to complete a process by as much as 80. Logix can help you save up to 80 keystrokes per process. You can use the calculator to see for yourself.

Use intelligence and automation to increase reimbursements for patient care and overcome revenue cycle and patient access challenges. Despite the advances AI and automation are making in automating patient access, revenue cycle processes, and staff with RCM, compliance, and clinical expertise, staff still need to be able to bill and reimburse patients accurately. Our clients receive complete technology and team coverage, as well as deep knowledge of complex reimbursement landscape. Our technology and team have learned from billions of transactions for top healthcare providers and 1400 payers in the United States. Our patient access platform allows for faster financial clearance for patients prior to care. It also provides complete coverage for obtaining eligibility verifications and benefit checks, patient estimates, and prior authorization approvals.

The Cohere Unify platform supports our intelligent prior authorization solutions, including touchless and predictive technology, evidence-based clinical information, and other advanced features. Our technologies reduce or eliminate the manual steps to create a fully automated process from end-to-end. This predictive capability allows health plans to virtually eliminate the prior authorization workflow steps. Instead, the system can automatically create specific care plans based upon patient and population auth data and claims, including multiple services which can be pre-approved before they are requested. Our touchless and predictive technology is based on clinical criteria that are based on evidence for certain specialties. Single sign-on functionality with Availity NaviNet and other common portal technologies. The rules configuration and deployment has been proven to scale across millions of transactions.

Cohere helps health insurance plans automate the prior authorization process in-house and end-to-end using clinical intelligence. Health plans can license Cohere’s PaaS intelligent authorization directly to their internal utilization management staff. Our client health plans are able to achieve significant administrative efficiencies as well as faster and better patient outcomes. Cohere offers a modular and configurable suite of solutions for health plans. Digitizes prior authorization requests and combines them into a single automated workflow. Automates prior approval decisions using policies preferred by health plans and accelerates manual reviews. Using AI/ML and automated capabilities, it helps clinical reviewers to adjudicate complex requests. Utilizes AI/ML, advanced analytics and clinical intelligence to improve utilization management performance. Innovative, specialty-specific programs improve patient and population outcomes.

Real-time transactions within existing technology platforms enable seamless workflow. Providers and payers can save up to 90% on benefits and utilization management by reducing time and effort. Eliminate the current benefits management black box and eliminate confusion for patients, payers and providers. Patients, providers, and payers will have more time to focus on their care with self-learning automation and fewer clicks. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates the automated workflow and rules engines based upon actual responses and results from provider/payer interactions. Our technology adapts to the rules used by payers. It gets smarter the more you use it. A library of thousands of rules that are constantly updated for all payers, whether they be national, state, or regional.

Securely and easily access multiple endpoints with one API connectivity. This allows you to avoid creating one-offs for disparate healthcare systems. A single point of access is all that is needed to bridge the gap between multiple systems, data sets, and standards. Consensus Harmony provides universal healthcare APIs and cloud fax APIs for electronic signatures. It also connects to other EHR partners and leading industry cloud marketplaces. Flexible interoperability options allow programmatically integrating digital faxing and secure messaging, patient records requests, esignatures and more into key workflows such as payments, prior authorizations and referrals. Partnering with community providers that are already integrated will allow you to expand your capabilities and gain access to new information networks. Don't limit your network, let technology dictate the mode of communication.

Veradigm AccelRx is a free, automated, comprehensive solution that helps you streamline specialty medication fulfillment for patients. You will have better outcomes and medication adherence, and your staff will receive fewer phone calls or faxes. AccelRx combines electronic enrollment, consent authorization, prior authorization and script into one system that can significantly reduce time-to-fulfillment for specialty drugs with any payer. With a click, automatically populate patient data on enrollment forms and other forms. One platform that simplifies specialty medication management. You can now manage most specialty drugs from one place, including electronic prior authorisation (ePA). Your existing electronic health record (EHR), will allow you to access your enhanced specialty medication management.

You are dealing with staff shortages and rising costs - interest rates, salaries, systems. Everywhere you look, you'll see struggling practices. It doesn't have be this way. We have the answer. OmegaAI can help you solve your staffing problem. After creating an account, Omega AI can be used immediately. A clearer, more focused interface saves time and eliminates unnecessary clutter. Facilitate interconnection between facilities and organizations. Blume, our integrated patient portal, allows patients to take control of their own health. Patients can access the entire medical imaging journey using their smartphone. They can upload prior images, insurance information, history and prior images, verify eligibility, make payments, schedule appointments, view their images and reports, as well as share their images with family and friends.

MediFusion is an integrated suite of software that offers innovative EHR solutions and medical billing to healthcare practices. It also enhances clinical, administrative and financial processes. We are available to help you with any questions or concerns you may have. Our all-in-one integrated system will automate and speed up your clinical processes. A system that manages all revenue cycles from Eligibility Verification through to Claim Processing, and finally getting paid. Our cloud-based Electronic Health Record software is a scalable and integrated solution that will help you improve the quality of patient care. This web-based EHR allows you to document and access your Clinical and Financial data from any internet-ready device, no matter where you are.

Valer's technology simplifies and speeds up prior authorization and referral management. It automates submissions, status checks, verification, reporting and EHR synchronization for all medium-to-large healthcare settings, specialties and payers on one platform. Valer is a technology solution that caters to all specialties and payers. It was designed for your needs, not for ours. Valer is specifically customized to meet your needs, unlike off-the shelf products that limit specialties and service lines or payer mix. Valer's dashboard is so easy-to-use that it increases staff productivity and simplifies staff training. It also measures staff and payer performances across all service lines for continuous improvement. Valer connects to all of your payers, not just some. We connect to all payers, for all specialties and service lines. Real-time updates on payer rules are also available.

The iMed electronic prescription system iMed eRx starts at $43/month. It can be used to write both EPCS compliant and legend prescriptions. This software is certified for e-Prescribing across all 50 states. Our software supports formulary support and electronic prior authorization. Our key features include Drug-Drug, Allergy and Disease interaction checking. Database of drug stores with frequent updates. Drug therapy monitoring. 24/7 monitoring of script delivery.