Harmony is a comprehensive PA Management platform, for both medical and pharmacy prior authorizations (PA) designed by clinicians for clinicians. Harmony addresses the needs of providers who submit PA requests as well as payers who review requests. Harmony’s user interface is intelligible requiring minimal training for end users, it allows users to arrive at a PA decision in just a few steps, and creates a full clinical data pathway continuum from the prescriber to the payer, by integrating provider and hospital Electronic Health Record (EHR) systems with the Health Plan and/or PBM’s Formulary, claims, and PA criteria and PA systems.
Harmonious integration is achievable with all existing software solutions offered by a Health Plan or PBM
Harmony optimizes the reviewer’s ability to complete a PA review in a fraction of the time required to review PAs traditionally by streamlining the PA workflow and presenting all relevant clinical information. Harmony can instantaneously search, identify, and list all relevant clinical information pertaining to specific PA criteria from hundreds of pages of supplemental documents submitted by providers. Harmony analyzes all incoming PAs for complexity allowing an equitable distribution of PA to all reviewers of simple and complex cases. Harmony’s reporting dashboard provides real-time monitoring of all PA’s with multiple built-in alerts to help ensure compliance with all regulatory and internal requirements. Harmony communicates directly with existing EHR systems alleviating many of the bottlenecks of PA management for hospitals and health plans. Harmony not only automates submission of PAs through the integration with medical records, it also digitizes the Request for Information (RFI) process by directly accessing and retrieving clinical data that is crucial in the PA review which saves prescribers precious time which can be redirected to direct patient care. If a PA is denied by a Health Plan or PBM, Harmony communicates the denial reasons(s) to the provider and creates an uncomplicated appeals process to aid in peer-to-peer review benefitting both provider and payer.
According to the 2019 annual CAQH Index report, the average industry cost for manual prior authorizations rose 41% in 2019 signaling the need to create a unified process that connects payers and providers. The solution is Harmony’s full clinical data pathway continuum, simplifying the flow of communication and delivering countless efficiencies for providers and payers.
Harmony comes pre-bundled with Virtuoso AI and Concerto Suite.
Virtuoso AI is a microservice which can integrate into existing PA Management platforms and EHR systems. Virtuoso provides a comprehensive and cohesive PA process from submission to decision, resulting in numerous efficiencies for both payers and providers, without disrupting existing incumbent platforms.
For Health Plans and Pharmacy Benefit Managers (PBM):
Virtuoso addresses the greatest challenges faced by Health Plans and PBMs surrounding PAs: narrow Turn-Around-Times and review of complex PA criteria.
How does Virtuoso Work for Health Plans and PBMs?
Virtuoso extracts clinical information from PA requests, compares the clinical data and information against the payer’s clinical criteria and then accurately predicts if the request should be approved or denied. The AI model determines if there is missing information or additional supportive documentation is needed to complete the review and can flag PAs which require further clinician review. Virtuoso goes beyond decision support, Virtuoso’s proprietary model provides transparency to the PA process by generating the specific reason for approval or denial, ensuring compliance with internal audits as well as all regulatory agencies. Virtuoso learns, adapts, and improves itself as it processes more and more PAs. There are no limits to the efficiencies that Virtuoso can provide for your utilization management team.
For Providers and Hospital Systems:
Virtuoso integrates with Electronic Health Record (EHR) systems and delivers real-time access to PA decisions. This partnership significantly decreases the resources currently needed and utilized by prescribers for submission and processing of prior authorizations allowing resources to be reallocated to direct patient care. In addition, patients have an improved patient experience due to reduced wait times for medications that require prior authorization and enhanced access to care.
How does Virtuoso Work for providers and hospital systems?
Through Virtuoso’s integration into the EHR system, patients’ records and prescribers’ notes are utilized to assist prescribers in selecting the most appropriate medication based on the patient’s Health Plan/PBM’s Formulary and Prior Authorization criteria requirements. When more cost-effective formulary alternatives are available, Virtuoso provides an intelligent alert to the prescriber in real-time. If the prescriber chooses a drug which requires a PA, Virtuoso uses the EHR data and the patient’s Health Plan/PBM PA criteria to determine the likelihood of an approval. If additional clinical information is required for the PA, Virtuoso informs the prescriber exactly which information is needed. Virtuoso eliminates the need for prescribers to fill out lengthy PA forms and submit pages and pages of patient’s health records to the Health Plan or PBM. Virtuoso’s real-time response of Formulary and PA requirements also ensures that patients have significantly reduced wait times for PA determinations and for medications at the pharmacy.
Concerto Suite is a complete PA intake and submission tool that can integrated into any PA Management platform or EHR system on the market today. Concerto is built to eliminate the frustrations resulting from current PA submission methods including fax, phone, and electronic PAs. Concerto saves critical resources of time and money by creating a one stop shop where all PAs submitted are transformed into a searchable format regardless of submission type. Concerto was designed by clinicians who have years of experience with PA systems across the healthcare landscape to alleviate problems that are faced industry wide.
For Health Plans and PBMs
Concerto cuts PA reviewers time slogging through lengthy PA submissions that sometimes have over 50 pages of supporting docs by utilizing keyword search. All PAs upon submission are converted to searchable documents instantaneously. This is crucial for meeting strict Turn-Around-Time requirements in PA review plus greatly improves overall PA productivity. Concerto is built to be integrated with all leading electronic Prior Authorization (ePA) providers as well as call centers handling faxes and phone calls.
Pairing Concerto Suite with Virtuoso is another option provided by Banjo that allows deeper integration with PA management needs and requirements.
Banjo also offers an all-in-one PA Management Platform (Harmony) with built-in Concerto Suite and Virtuoso AI.