The delay between when a medication is prescribed and when the patient can receive the prescription is a critical issue in patient care, particularly for specialty pharmaceuticals whose reimbursement can be a challenging hurdle. Many patient-support (hub) service providers, including Lash Group, have addressed one aspect of this with accelerated prior-authorization procedures. Now, Lash is addressing another aspect with AI-powered electronic benefits verification (eBV).
According to the company, a proprietary artificial-intelligence platform, branded as SmartPoint, powers an eBV process that takes advantage of the stored knowledge of “health coverage and payer data collected from millions of manual verifications as a reference base.” With the addition of machine-learning capability as well, the eBV process can predict the outcome of an incoming BV with a measurable degree of certainty, based on the patient’s health plan and other details. If the accuracy of the measurement is high enough, the BV is processed in real time and a benefit summary is sent to the patient’s provider. Lower accuracy, and the BV is routed to a Lash patient counselor for evaluation. The machine-learning capability enables the system to react to new information from counselors and from health plans, so the process can continually improve.
“Benefit verification can be a significant barrier … for the millions of patients whose benefits are still verified manually – through phone calls and paperwork exchanged among provider offices, payers and third-party hub support services providers,” said Tommy Bramley, PhD, president, in a statement. “By applying advanced technologies to the healthcare space and pairing them with expert human intervention when required, we can drive faster speed to therapy and provide a more seamless experience for patients and providers.”