Edifecs and AMA Experts to Present at WEDI on Approaches to Streamline Payer-Provider Administrative Processes

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Ripe for Improvement, Automation of Prior Authorization Processes Can Speed Payment and Reduce Denials

Edifecs, Inc. healthcare information technology expert Deepak Sadagopan will join the American Medical Association’s (AMA) Tammy Banks to discuss how technology can help automate the U.S. healthcare system’s claims management process – particularly prior authorization – at the 22nd Annual WEDI National Conference in Las Vegas this week. This year’s conference focuses on the issues currently facing the healthcare industry, how they will affect healthcare businesses and their partners, and ways the industry can work together to create more efficient strategies for approaching these new challenges.

The session, “The Evolution of Prior Authorization and How Technology Will Help,” will provide a broad understanding of how prior authorization processes work today, the challenges associated with manual systems, and the new approaches taking hold, thanks to automation. Inefficient healthcare claims processing, payment and reconciliation cost the healthcare industry billions every year.

WHEN: Wednesday, May 15, 2013 at 4:00 p.m. – 5:30 p.m. PDT

WHAT: Prior authorization and the claims management process needs to evolve from a highly manual, nonstandard, ambiguous process to an automated, transparent system of real-time healthcare transactions. The presenters will share the results of a 2010 survey conducted by the AMA and the Federation of Medicine Prior Authorization Experience showing that an overwhelming majority of respondents said the current prior authorization process was burdensome, it needed to be streamlined and that doing so would help them manage patient care more effectively. The AMA, working with other industry stakeholders, is proposing electronic prior authorization (ePA) as one method for streamlining the prior authorization process.

This session will also give attendees:

  •     A deep understanding of how automating the prior authorization system would benefit both payers and providers by standardizing the process, reducing manual follow-up and streamlining overall workflow.
  •     Increased familiarity with the business, technology and system integration requirements needed to successfully implement automated prior authorization.
  •     Detailed information about the AMA’s proposed ePA solution designed to reduce time spent on hold, standardize prior authorization procedures, simplify the administrative process, lessen denials, and ensures a practice is staying current with the latest payer rules.

WHO: Deepak Sadagopan, General Manager of Clinical Solutions and the Provider segment at Edifecs, is a recognized leader and domain expert in healthcare IT with more than 16 years in leadership roles for top Fortune-rated corporations such as McKesson Corporation, Quest Diagnostics and Siemens. In these positions, he directed key initiatives related to Meaningful Use compliance, health information exchanges, and launching the largest clinical transaction network in the United States, which serves more than 200,000 physician environments. Sadagopan has been actively involved in several industry bodies such as the eHealth Initiative, CCHIT, and HITSP. Currently he sits on the Cal eConnect technology advisory board and provides the organization with leadership guidance on HIE governance and technical infrastructure. He earned his master’s degree in engineering from the University of Connecticut, and is a graduate of the Executive Program from the MIT Sloan School of Management.

Tammy Banks, Director of Physician Practice Integrity, Efficiency and Management at AMA is responsible for promoting physician practice efficiency through administrative simplification and physician practice clinical data integrity on behalf of the AMA’s Private Sector Advocacy Group. She works closely with state, county, and specialty medical societies to confront unfair managed care practices nationally and at the local level. Prior to coming to the AMA, Ms. Banks served as the director of Socioeconomic Affairs and Research and was responsible for the health policy, practice management, reimbursement and research areas for the North American Spine Society. She received her Master’s degree in Business Administration with an emphasis in Quantitative Methods from Roosevelt University, in Chicago, Illinois; a Bachelor of Arts degree from Alma College, in Alma, Michigan; the Coding Procedural Certification—physician based (CPC-P) from the American Health Information Management Association, and most recently received the Certified Medical Practice Executive (CMPE) certification from the Medical Group Management Association.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

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