Rising above the authorization gridlock:
Is your utilization management (UM) process drowning in inefficiency, delays, and rising costs?
May 02, 2025
Prior authorization gridlock is crushing your business.
Prior authorization (PA), in its current form, is undermining the effectiveness of utilization management (UM). Today’s UM process faces several critical challenges:
The problem isn't just outdated systems – it's a broken process.
The current utilization management paradigm creates friction and frustration for everyone involved. Imagine a utilization management process that not only cuts costs and improves efficiency but also empowers your team, strengthens provider relationships, and delivers exceptional member experiences.
Finding the friction: How we uncovered challenges in the auth process
After analyzing data, reviewing provider feedback, and sifting through patient surveys, we discovered a decent amount of friction holding back the authorization process. For patients, providers, and health plans, an inefficient auth process means:
• Delays in care delivery: Authorizations that get caught in the system translate into poor patient experiences and unrealized care. It also leads to higher costs for payers and unpredictable revenue cycles for providers.
• Unnecessary administrative costs: Manual tasks, duplicated efforts, and communication breakdowns cause significant drops in efficiency. Providers are taken away from what matters and health plans get bogged down in a backlog of tasks.
• Inaccurate criteria: Without a consistent auth process, patient data can come from many sources. Outdated or misrepresented criteria can lead to faulty cost assessments, wrong diagnoses, and higher admin costs.
•Convoluted communications: Patients, providers, and administrators all need to be on the same page for effective care delivery. Without a reliable communication process, there can be too many channels to monitor. Faxes, mail, and phone calls to name a few.
•Ever-evolving regulations: An inconsistent, manual auth process poses many regulatory challenges when it comes to compliance. Without a streamlined digital footprint, keeping up with regulatory changes, compliance standards, and audit timelines is virtually impossible.
For many in the industry, these challenges aren’t exactly surprising. According to McKinsey, “...clinical staff must devote considerable time to reviewing [authorization] requests. Meanwhile, doctors and staff report spending 13 hours per week on [authorizations]; many clinicians believe it undermines their clinical judgment and can inhibit timely care.”
Transform UM into a strategic asset.
enGen provides a solution that transforms utilization management from a bottleneck into a competitive advantage – cutting prior authorization costs by 75% and dramatically improving member access to care.
Introducing Predictal Auto-Authorization: The scalable, sustainable solution you need.
Predictal™ Auto-Authorization modernizes utilization management tasks by replacing fragmented, short-term solutions with a smart, integrated platform built for scale. It’s anchored around three core pillars:
Real-World Results That Speak for Themselves:
The metrics above showcase just a glimpse of how Predictal™ drives measurable business outcomes and enhances member experiences by fast-tracking access to treatments. Stop struggling with outdated systems and unlock the true potential of your utilization management