Palmetto GBA recently announced it received a KLAS Research Points of Light Recognition Award for a pilot project to streamline prior authorization requests between payer and provider.

The Points of Light Recognition Award is part of the new Payer/Provider Initiative, which focuses on facilitating trust and teamwork among payers, providers, and health care information technology vendors. KLAS’ Points of Light Report features successful efforts and partnerships to reduce cost and inefficiency.

Palmetto GBA Assistant Vice President, Robin Free, and partner Cedar presented the pilot project on May 24 and 25 at the KLAS Research Payer/Provider Summit 2022. The team joined forces with Conway Medical Center to reduce the manual work required of health care staff to get prior authorization for certain procedures, imaging, and labs done in hospital settings.

"Palmetto GBA is honored to have been recognized by KLAS as part of their Points of Light Awards. Our pilot program reduces administrative burden and allows for faster prior authorization decisions, which stands by our commitment to creating value by continuously transforming ideas into technical and administrative solutions that improve service, quality, and cost. " – Robin Free, Assistant Vice President

The project used Cedar’s electronic health records (EHR) interface, Optic, to support Palmetto GBA's Outpatient Hospital Department Prior Authorization program. With Optic, Palmetto GBA's nurses can view parts of the medical record of a Medicare beneficiary directly from the provider's EHR system. Being able to view records eliminates the need for the provider to submit medical records to Palmetto GBA manually for review. This frees up staff for other critical needs. Early results of the pilot program include a reduction in errors, a decrease in manual work needed, and faster decision turnaround times.

A case study on the outpatient prior authorization program is included in the KLAS Points of Light Report. To review the study, please visit www.KLASresearch.com.