11:44 AM

TransUnion Healthcare Speeds up Prior Authorization Process, Reducing Provider Administrative Costs

Company also enhances Insurance Eligibility solution to integrate directly with market leading Electronic Health Records (EHRs)

To help further improve the patient experience at hospitals and health systems, TransUnion Healthcare (NYSE:TRU) today announced the expansion of its Patient Access solution suite with the launch of its Prior Authorization solution and the enhancement of its Insurance Eligibility offering.

TransUnion’s Prior Authorization solution helps ensure providers will be reimbursed for the patient care services they provide. The company’s Insurance Eligibility solution has been enhanced to help streamline front-end workflows by integrating directly into hospital electronic health records (EHRs). Together, the solutions will help improve overall revenue cycle efficiency.

TransUnion is leveraging its market leading Insurance Eligibility Clearinghouse, which currently processes millions of transactions daily and is primarily delivered to ambulatory providers via channel partners, to expand its offerings to hospital providers. The offerings will be featured at the National Association of Healthcare Access Management (NAHAM) Annual Conference.

“This year’s NAHAM conference is all about the patient experience. We can now help providers reduce the time to complete the prior authorization process, benefitting patients as well,” said John Yount, vice president of product for TransUnion Healthcare. “TransUnion’s Insurance Eligibility and Prior Authorization solutions also drive productivity, lower administrative costs and reduce uncompensated care costs.”

Streamlining and standardizing the prior authorization process

TransUnion Healthcare’s Prior Authorization solution allows providers to confirm if an authorization is required for medical procedures prior to service. This upfront screening helps providers reduce downstream rework, lower administrative costs and prevent denials that can result from missing prior authorizations.

Registration staff have access to TransUnion’s Prior Auth Library℠, which contains more than 1.5 million payer-specific prior authorization rules for more than 16,000 procedure codes covering 92% of U.S. insured lives.

The solution delivers:

  • A single rules library that combines payer-published rules and the provider’s authorization rules, providing central access to the right rules at the right time, all in one place;
  • Easy online access to the most up-to-date prior authorization requirements across payers;
  • Immediate response as to whether an authorization is required for a specific procedure, enabling fast decision-making;
  • Seamless integration with TransUnion Healthcare’s ClearIQ solution, simplifying workflows with task-driven, exception-based work queues;
  • Integration to third-party patient access solutions and EHRs via application programming interfaces (APIs)

“Managing prior authorization requirements is an extremely manual and time-consuming process for providers. Registration staff are typically forced to rely on spreadsheets, binders and/or sticky notes to keep track of authorization requirements and changes to payer rules,” said Yount. “TransUnion helps to alleviate this burden by continually monitoring and staying abreast of insurance plans and changes to payer rules to ensure they have access to the most up-to-date information to complete their tasks.”

Hospitals secure more accurate eligibility and benefit information upfront

TransUnion’s Insurance Eligibility solution allows hospitals to verify patient coverage, including copays, coinsurance, and deductible information.

The solution delivers:

  • Connectivity to more than 800 payers, covering 98% of U.S. insured lives;
  • Multiple delivery options for eligibility information, including integration with Epic and MEDITECH patient registration systems and batch transactions, to meet hospitals’ different needs;
  • Optimized 271 eligibility responses that display eligibility data in an easy-to-read summary, helping hospital staff quickly find and interpret key eligibility information;
  • Intelligent recursive search that automatically runs multiple queries to find the best payer response

“The Insurance Clearinghouse is optimized to deliver 99.9+% uptime by leveraging modern IT technology that ensures minimal disruption to hospitals’ workflow. Hospitals also receive access to TransUnion’s industry-leading insurance clearinghouse customer service team that maintain a 97.5% customer satisfaction rating,” added Yount.

The expansion of Insurance Eligibility and the addition of Prior Authorization round out TransUnion’s Patient Access solution suite to both hospital and ambulatory providers, which includes Identity Verification, Medical Necessity, Patient Payment Estimation, Financial Aid, Propensity to Pay, and Charity Assessment. The easy-to-use solutions let staff engage patients early—and target point-of-service collection.

For more information about TransUnion Healthcare’s Patient Access solutions, please visit

About TransUnion HealthcareTransUnion Healthcare, a wholly owned subsidiary of credit and information management company TransUnion, is a trusted provider of revenue cycle management solutions for maximizing reimbursement, improving patient engagement, and ultimately increasing the effectiveness of the healthcare system. We deliver this by leveraging our data assets, market-leading revenue cycle management technologies, and deep insights into consumer financial behavior, to help providers reduce uncompensated care and improve cash flow with one of the most patient-centric revenue cycle management systems on the market today.

About TransUnion (NYSE:TRU)

Information is a powerful thing. At TransUnion, we realize that. We are dedicated to finding innovative ways information can be used to help individuals make better and smarter decisions. We help uncover unique stories, trends and insights behind each data point, using historical information as well as alternative data sources. This allows a variety of markets and businesses to better manage risk and consumers to better manage their credit, personal information and identity. Today, TransUnion has a global presence in more than 30 countries and a leading presence in several international markets across North America, Africa, Latin America and Asia. Through the power of information, TransUnion is working to build stronger economies and families and safer communities worldwide.

We call this Information for GoodSM