WNS Consult™ helps streamline and accelerate prior authorizations

Prior authorization (PA) is one of the most obstructive practices in the US healthcare system, delaying care and adding unnecessary administrative burdens. PA introduces unnecessary layers of bureaucracy that delay care, frustrate healthcare providers, and leave patients without timely treatment. Health plans require healthcare providers (HCP), patients, or other providers to obtain approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. This practice is unique to the health insurance industry and not commonly found in other sectors, such as home or auto insurance. Because the process is onerous, it must be streamlined to improve its efficacy in keeping with CMS regulations. Technology enablement provides the best opportunity to address this issue.

Address the hidden complexity to unlock efficiency

Prior authorization is not a one-size-fits-all process, considering each health plan often has unique forms. Even within a single plan, different conditions or treatments may require different forms and associated supporting documentation. The patient might need multiple PAs for various treatments. This diversity creates room for confusion and error, leading to treatment delays and frustrating providers and patients. A typical PA process involves several steps that can introduce delays (see Exhibit 1).

Exhibit 1: PA is simple in theory but a care-delaying activity when implemented

Source: HFS Research, 2024

Process delay bottlenecks must be identified, and solutions implemented to streamline the process by reducing manual input and minimizing room for error (see Exhibit 2).

Exhibit 2: Combining process and IT expertise can help solve prior authorization issues by automating unnecessary steps

Source: HFS Research, 2024

WNS Consult streamlines PA and democratizes its use

PA often requires non-clinical staff to input complex clinical data, increasing the likelihood of errors and causing delays. Simplifying the PA process transforms a non-clinical staff nightmare into a streamlined, user-friendly experience. The WNS Consult™ goal is clear: collaborative care delivery through evidence-based guidelines, accelerated prior authorization requests, focusing on behavioral changes vs. denial, reduced errors, and improved overall healthcare delivery and experience. For healthcare enterprises, this means fewer administrative headaches, decreased delays in patient treatment, and improved operational efficiency.

WNS Consult addresses the challenges of prior authorization without drowning in AI buzzwords. While many tout AI as the solution to every problem, Consult’s strength lies in its focus on integrated workflow optimization (EMR, InterQual, HealthPlanet, etc.), efficiency (>70% portal adoption, 67 NPS), and automation (>80%). The platform effectively automates repetitive, time-consuming tasks such as data entry, document uploads, and eligibility checks involved in prior authorization, reducing submission times and eliminating unnecessary human errors such as inaccurate CPT codes and incomplete documentation submissions.

WNS Consult has driven more than 90% of prior authorization submissions online via the web, compared to the industry average estimate of 30-40%. This shift represents significant time savings for healthcare providers, with online PA requests completed in 4-5 minutes, compared to 8 minutes for phone-based submissions. Over time, these savings accumulate, reducing operational costs and freeing up valuable resources for patient care. The platform optimizes the process from start to finish—streamlining data entry, reducing the likelihood of rejections, and enabling faster adjudication of requests.

To address issues with request completion, WNS Consult minimizes downtime or the need to restart applications through built-in chatbot support and live agent assistance. This ensures users don’t face bottlenecks, enabling them to resolve issues quickly. They also provide peer-to-peer consultations, increasing overall satisfaction and provider engagement by ensuring expert clinicians are always available for personalized guidance and support.

The Bottom Line: Enabling the right type of technology, using smart tech—with clinicians in the loop—will improve PA outcomes for patients, providers, and payers.

Healthcare enterprises must move beyond tackling the day-to-day challenges of prior authorizations and focus on how systemic inefficiencies are inflating costs and undermining care delivery. WNS Consult offers a robust solution, empowering non-clinical staff and enabling providers to reduce administrative overhead while accelerating patient care. In a world where PAs feel like a necessary evil, WNS Consult turns the challenge into an opportunity for operational excellence and patient-first care.