Disconnected workflowsSpecialist requirements
In 2020 a US hospital's revenue-cycle staff worked between clinical systems and many insurers. Before a scheduled procedure they had to learn whether the payer required prior authorization, look up that payer's rules, and pull supporting documentation from the electronic health record; prior authorizations were the most costly and time-consuming provider transactions of 2019 and among the top reasons care was delayed OL1. After care, claims passed through a clearinghouse to payers, and an estimated one in seven US claims was rejected, forcing rework and delaying payment OL2. Each step lived in a different system with its own payer-specific rules, so a gap at one point held up both the patient and the hospital's cash OL1 OL2.