Merge Healthcare, an IBM Company (NYSE: IBM), has entered into an agreement with eviCore healthcare that will automate and streamline the process providers undertake to obtain imaging study prior authorizations from payers. The agreement is intended to benefit payers, providers and imaging centers by consolidating multiple prior authorization processes into Merge’s iConnect® Network Services (iCNS), a comprehensive technology-based solution which electronically routes imaging study orders, manages incoming prior authorizations and communicates medical imaging results among healthcare professionals in a HIPAA-compliant manner.
“The overall cost to the healthcare system of all practice interactions with health plans, including authorizations, is estimated between $23 billion and $31 billion annually,” said Justin Dearborn, chief executive officer of Merge Healthcare. “The Merge-eviCore agreement is intended to benefit providers and payers by applying a technology-based solution to what has been a largely analog process. In doing so, Merge and eviCore expect to bring a new level of operational efficiency to imaging centers and referring physicians, with the potential to help lower the risk of providers going unreimbursed for medical payment claims based on incomplete or absent prior authorization documentation.”
Starting in 2016, referring physicians, hospitals and medical imaging centers that work with Merge can access prior authorization information for more than 90 million insured individuals currently served by eviCore. Since Merge’s iCNS is vendor neutral, even medical imaging providers not yet working with Merge are expected to benefit from the enhanced iCNS platform, which will be designed to accommodate virtually any Radiology Information System (RIS) or Picture Archiving Communications System (PACS), as well as multiple payer processes.
“eviCore handles thousands of prior authorization cases per day, and the associated process to manage them has to date required a tremendous amount of manual effort from providers and payers,” said Matt Cunningham, executive vice president of M&A integrations and value improvement programs at eviCore. “We chose Merge as our partner to address this challenge because Merge is the only company with infrastructure in place to enable automated ordering, prior authorization and imaging results delivery for the entire marketplace. The potential benefits for our payer clients and the providers they serve are considerable.”
Prior authorization programs for medical imaging services, also known as pre-certification programs, are commonly required by payers. The programs are designed to promote effective use of imaging services and confirm the medical necessity of a requested radiology service. Prior authorization requirements vary among payers, but studies show it can take up to an additional 10-20 hours a week per physician. In 2013 alone, an estimated 97 million prior authorization requests were made for medical imaging services such as computed tomography scans (CT scans), magnetic resonance imaging scans (MRIs), medical ultrasonography and more.
Casalino, Larry. "What Does It Cost Physician Practices To Interact With Health Insurance Plans?" Health Affairs, Aug. 2009. Web.
About eviCore healthcare
eviCore healthcare offers proven, diversified medical benefit management solutions that help clients reduce costs while increasing quality of care for their members. The company provides these solutions to managed care organizations and risk-bearing provider organizations serving commercial, Medicare, and Medicaid populations. Powered by a team of specialized medical professional resources, extensive evidence-based guidelines, and advanced technologies, the company supports clients by ensuring the right evidence-based care is delivered at the right time to the right patient at the right site of care. Flexible medical benefit management solutions are offered in: Diagnostic Testing and Imaging; Cardiology; Comprehensive Musculoskeletal and Pain Management; Medical and Radiation Oncology; Sleep Services; Lab Management; and Post-Acute Care (including participating in the CMS Bundled Payments for Care Improvement initiative). eviCore is proud to help over 90 million Americans receive higher quality, lower cost healthcare. For more information, please visit evicore.com.
About Merge Healthcare
Merge, an IBM Company, is a leading provider of innovative enterprise imaging, interoperability and clinical systems that seek to advance healthcare. Merge’s enterprise and cloud-based technologies for image intensive specialties provide access using a standard internet browser or mobile device. Merge also provides clinical trials software with end-to-end study support in a single platform and other intelligent health data and analytics solutions. With solutions that have been used by providers for more than 25 years, Merge is helping to reduce costs and improve efficiencies, which enhances the quality of healthcare worldwide. For more information, visit merge.com and follow us on Twitter @MergeHealthcare.
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