I’m wanting to start working on handling prior authorization EDI to Medicare. Looks like NGS has a pretty good process setup. Are there any providers out there that would like to help build the process and get some free prior-authorization processing in the mean time?
At first the process will be only on my portal, then once we get that worked out and the api fully flushed out I’ll put in my module in openEMR and connect it to the patient dashboard and such.
If anybody does prior-auth and wants to help out let me know! I’m open to other payers as well, but I see NGS is already ready to go and I already have connections so it should be an easy path.
Process as I see it now:
Create the prior auth and upload the C-CDA R2.1, hopefully OpenEMR can produce that, then my system would create the EDI and send the attachment when it’s time. I’ll display the results and we can decide what data is needed to be imported into OpenEMR.
I have a separate process that is expensive that I sell. The price is just to much though. I’m looking into prio-auth all the time, I’m going to get it accomplished but it’s going to end up being very payer specific; I think. There have been laws passed that are requiring API’s at the payers to do it and I think the prio-auth landscape is going to be changing a ton in the next few months.
I’m working on a integration with United right now that will have their prior-auth flavor. I started first with a claim pre-check option and moving toward the prior auth and attachments path next.
I haven’t looked at medicare in awhile, but if it’s still the old way I’ll hold off on it. Everything is moving to real-time fhir API’s.
I had a conversation with another clearinghouse. They have the same issue is that it won’t be a standardized system like x12. Each payer will have their own flavor and many payers have not begone to work this thing out. I am pushing trying to get on the cutting edge of this but it will be like eRx. The margins are so thin. It is not worth doing.