Prior Authorisation Delays and Claim Denials
Definition
Manual prior authorisation processes cause treatment delays for 78% of patients and significant administrative time, resulting in denied or reduced reimbursements for eligible services.
Key Findings
- Financial Impact: 12 hours/week per physician; 78% of cases delayed leading to claim denials or partial payments (AUD 1,000+ per high-cost inpatient claim)
- Frequency: Per high-cost treatment request (inpatient, elderly care)
- Root Cause: Manual form submission via email/fax/post with 5-day lead time; incomplete documentation errors
Why This Matters
The Pitch: Services for the Elderly and Disabled providers in Australia 🇦🇺 waste 12 hours/week per physician on manual prior authorisation. Automation eliminates denials and delays.
Affected Stakeholders
Care coordinators, Administrators, Providers
Deep Analysis (Premium)
Financial Impact
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Current Workarounds
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
Patient Treatment Delays from Manual PA
Administrative Burden on Providers
NDIS Incident Reporting Penalties
Governing Body Determination Application Fees and Delays
Assessment Waiting List Delays
Non-Compliance History in Reassessments
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