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Apixio’s New Apicare AuthAdvisor Leverages Machine Learning, Predictive Decision-Making

Apixio, Inc., the healthcare analytics company, announced the launch of its new Apicare AuthAdvisor, which uses machine learning and predictive analytics to automate prior authorization decisions for payers. By leveraging historical decision data, AuthAdvisor automates approval for payers, medical benefits managers, and other vendors to deliver decisions within seconds rather than days, and reduces manual reviews by over 50%.

According to the Council for Affordable Quality Healthcare (CAQH), “the cost to complete a prior authorization remains the single highest cost for the healthcare industry at $13.40 per manual transaction and $7.19 per partially electronic web portal transaction.” Not only is it costly, but it is also an administrative burden with manual reviews sometimes taking days or weeks, which delays patient treatments, creates obstacles to care, and potentially negatively impacts clinical outcomes.

Apixio’s AuthAdvisor solves these problems by automatically approving diagnostics and procedures based on historical data and decisions made by the provider and payer.

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“This is a new way to use data science to accelerate one of the most burdensome aspects of healthcare delivery,” said Apixio CEO Sachin Patel. “AuthAdvisor relies on the accuracy of an organization’s past decisions to process approvals, rather than relying on rules-based approaches that are tedious to maintain and often result in a high number of manual reviews. With AuthAdvisor, approvals are delivered at the speed and scale that today’s high-performance healthcare environments demand.”

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With Apixio’s Apicare AuthAdvisor solution, organizations can:

  • Drive cost savings by reducing the volume of unnecessary reviews with automated decisions driven by our AI models
  • Fine-tune thresholds with user-enabled controls on a procedure-by-procedure basis
  • Deliver immediate results by deploying into existing workflows through APIs
  • Enhance provider and member satisfaction with timely feedback on requests

“The AuthAdvisor system is transparent and customizable, giving payers and benefits managers the visibility and flexibility they need to feel confident in the decisions being made,” Patel said. “The latest addition to our AI platform, this technology has the potential to not only save tremendous time and money, but also greatly improve care delivery and member satisfaction for millions of Americans.”

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[To share your insights with us, please write to sghosh@martechseries.com]

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