Case Study: Priority Health speeds prior authorizations and boosts provider satisfaction with HealthEdge GuidingCare

Priority Health and GuidingCare® Team Up To Ease Preauthorization Pain Points

Priority Health, a health plan integrated with the not-for-profit Spectrum Health System, faced challenges with a high volume of preauthorization requests from providers, which created administrative burdens and delays. The vendor, HealthEdge, implemented its GuidingCare solution suite to address these pain points and develop a new electronic Authorization Portal.

HealthEdge's solution automated the preauthorization workflow, allowing for electronic submissions and near-immediate responses. This resulted in 80% of requests being auto-approved, reduced turnaround times to less than three days, and eliminated 20 items from the preauthorization list. The solution drastically reduced administrative burden and improved provider satisfaction for Priority Health.

Priority Health

Ann Donnelly

Vice President, Care and Utilization Management