Managing prior authorization in workers’ compensation is a key component to controlling costs, minimizing abuse, and managing absences. Cadence Rx Secure Managed Authorization Routing Technology (SMART) is advancing the process by combining a robust configurable scoring system, industry expertise and A/I.
The Cadence Rx SMART authorization process uses a combination of transaction driven variables, machine learning, prescribing patterns and clinical expertise to automate the routing/decision making process.
The use of an advanced authorization review process improves prior authorization response times and utilization review efforts, minimizing “rubber stamp” approvals by putting the decision in the right hands–resulting in reduced wait times and better outcomes for the patient.
Each of these variables can be included or excluded and weighted by the client to calculate the SMART Score. Every prescription that requires prior authorization is scored using these factors and then fed into the SMART Decision Engine to determine the appropriate course of action. Using customizable threshold levels and category weighting, the client can predefine responses, routing rules or escalation procedures. In addition, the score can be presented on the prior authorization management tool (Sōlis) as a metric to assist in the decision-making process.