The platform will be built on Salesforce Health Cloud, and Blue Shield will use HL7 FHIR standards to integrate more than 20 systems into one, according to an Oct. 21 news release.
Physicians will prompt the new solution to search a patient’s electronic health record for relevant clinical information and compile it into a pre-populated electronic form. Physicians will then be able to submit requests and members will receive answers during medical appointments.
If a clinical consultation is needed for the request, physicians will receive a message detailing what is needed to complete the authorization and options to begin a peer-to-peer meeting. Members will receive status updates on Blue Shield’s mobile app during the process.
“Prior authorization was never meant to be a barrier or a burden. As a health plan, it’s our responsibility to ensure safe, evidence-based, high-value care for our members, and we know it can be an easier process for everyone,” Blue Shield CEO Paul Markovich said. “That’s why we are taking the bold step to make it as easy as using your credit card, while enabling more coordinated, personalized support for members. It is time for the industry to let go of fax machines.”
The new platform solution will work alongside Blue Shield’s care management system, Care Connect. Eventually, the payer plans for prior authorization requests to automatically alert its nurses, social workers and behavioral health providers that a member may need new or increased services.
