Prior Authorization Electronic Submission and Adjudication

Community Health Center Network (CHCN)

As part of our mission to improve healthcare delivery though innovation in IT, Synergy built a system for Community Health Center Network (CHCN), a California-based managed healthcare organization, to help streamline their business administration process and expand their customer services digitally.

CHALLENGE: Business Problem

Despite of significant progress made by Health IT systems, many healthcare delivery workflows lacked necessary automation. CHCN was using an antiquated paper-based procedure approval process that delayed medical care. Thus, patients didn’t receive timely care.

PROCESS: What Has Synergy Done?
  • Working directly with the client, Synergy made use of an agile development methodology to provide value added features over the course of several product iterations. Following each development sprint, Synergy could accommodate the client’s needs and scope in a sustainable manner for the next iteration.
  • Synergy designed and developed a feature-rich, mobile-friendly web portal, CHCN Connect, that allows providers to submit prior authorization requests, search for existing claims and members, and manage user accounts.
  • Complementing the web portal, Synergy also built a responsive mobile app, Prior Authorization Adjudication by Medical Director (MD), that provides medical directors authorization requests (eligibility, case synopsis) in their “work queue”, where they can act on it without waiting for paper copy material.

BENEFIT

Faster Healthcare Delivery Process
  • Shortens adjudication lifecycle and allows doctors to spend more time treating patients
  • Removes dependency on mail/fax for medical documents and further automates and shortens the administrative process

Improved Business Process
  • Provides a streamlined, HIPPA compliant digital process for several customer service programs
  • Reduces errors and omissions associated with a paper-based workflow

Higher Client Satisfaction
  • Collaborating with the client during the development sprints kept all stakeholders involved and engaged.
  • Keeping the product backlog updated and prioritized between iterations allowed Synergy to quickly adapt to the changing needs of the client.
CASE STUDIES
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