Atlantic Health streamlines insurance authorization with intelligent automation

When the COVID-19 pandemic started, Atlantic Health System, like other healthcare providers, found itself under enormous stress. In addition to dealing with patients suffering the effects of a new virus, healthcare providers had to contend with new care protocols, staffing issues, and supplies shortages spurred by the pandemic, all of which placed additional pressure on any existing friction in healthcare administration processes.

“The pandemic and the aging population and growing population really put very high stress on every healthcare system, and Atlantic Health was no exception,” says Sunil Dadlani, chief information and digital officer and chief cybersecurity officer at the New Jersey-based nonprofit healthcare network. “You combine that with workforce shortages, supply chain shortages, and many other things that are going on.”

Atlantic Health serves a population of 6.2 million people, with more than 400 sites of care, including six hospitals, and as the organization struggled with these issues, it quickly became apparent that insurance authorization for imaging and radiology services — a foundational diagnostic step before almost any care can begin — was a bottleneck. When care is time-sensitive, any delays can affect patient outcomes.

Scheduling and receiving authorization for healthcare services has traditionally been a highly complex and manual process. Each of the more than 100 radiology practices across Atlantic Health System was responsible for its own authorization requests, which required significant investment of time and attention to administrative tasks.

“Our patients come from different backgrounds, and they have different payors. Each payor has its own formats, its own requirements, its own processes,” Dadlani says. “With the growing volume of radiology, it created a sense of urgency, because we were seeing a higher number of denials in pre-authorization. We saw a higher volume of additional documentation that was needed for pre-authorization.”

To address these challenges, Atlantic Health System undertook a project it called Prior Authorization Intelligent Automation, which has earned it a CIO 100 Award in IT Excellence.