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SCI Solutions offers platform to streamline insurance authorizations

SCI Solutions, an industry leading patient access, referral management and care coordination software firm, today announced the availability of insurance processing and authorization services, adding to its revenue cycle workflows and supporting end-to-end patient coordination across care communities.

This offering combines a proprietary analytics platform, enabling adherence to health plan payment and utilization guidelines, with a world-class service organization to deliver quick, accurate insurance authorizations. The insurance processing capabilities are embedded within SCI’s Provider Network Manager solution, a patient referral management platform, enabling SCI clients to more rapidly convert referrals into insurance-approved, schedule-ready appointments, ensuring payment of services and delivering an enhanced provider-patient experience.

Diagnostic Health Centers, headquartered in South Carolina and the largest provider of outpatient imaging services in the markets it serves, has successfully deployed SCI’s insurance processing and authorization services in its Beaumont and Port Arthur, TX markets. The insurance authorization service allows Diagnostic Health to offer referring providers a more simplified process for requesting and tracking authorizations for imaging services. Diagnostic Health will also be able to handle a higher volume of orders, have better payment data and schedule appointments more rapidly with fewer resources. 

“The growth and viability of our business depends upon delivering an advantaged service experience for patients and referring providers alike,” said Ed Field, director of imaging for Diagnostic Health Centers. “By adding insurance authorization services to the Provider Network Manager platform we already use, Diagnostic Health now offers referring providers a streamlined process to request and receive authorizations for imaging services. Patients benefit, too, from shorter approval times, more accurate insurance payment requirements and better communication between their referring providers and the imaging center, thus shortening the diagnosing time and getting to treatment faster.”

Health systems and providers spend between $23-$31B every year interacting with health insurance companies regarding payments and authorizations, and lack of authorization is a leading cause of payment denial. SCI’s solution addresses this growing need for care coordination technologies that can help providers avoid costly insurance denials and help bring increased reimbursement transparency to the front end of the revenue cycle.

“As the industry shifts to a value-based system of care, our clients are turning to SCI for reliable methods of improving their competitiveness and increasing patient satisfaction,” said Joel French, SCI’s CEO. “Insurance prior authorization requirements and related payment denials are high-priority pain points for providers. Diagnostic Health demonstrates how easily SCI clients can improve their referral-to-appointment conversion without leaving existing workflows.”

Earlier this month, SCI Solutions announced the acquisition of Seattle-based Clarity Health, a software-as-a-service company delivering insurance authorization and referral management services, enabling SCI to fulfill a growing need for insurance processing and authorization services in the market. Through a distribution and technology integration agreement jointly executed by SCI and Clarity Health in 2014, the solution is already being deployed among existing SCI clients, resulting in rapid adoption and substantial sales of the insurance authorization service.