Careviso's 2024 Audit Reveals Challenges in Diagnostic Testing
Careviso's Insightful 2024 Audit on Diagnostic Testing
Recent findings show rising denial rates and operational inefficiencies across the diagnostic testing landscape.
Careviso, an innovative player in healthcare technology solutions, has released its 2024 audit which analyses almost one million lab-based cases. This detailed examination illustrates persistent complexities and challenges in the prior authorization (PA) process confronted by both patients and clinicians in the U.S. diagnostic ecosystem.
The audit underscores a critical revelation: while prior authorization was initially intended to optimize service usage and manage healthcare expenditures, its current execution often leads to cumbersome administrative tasks that not only delay essential patient care but also amplify the burden on healthcare providers.
Analyzing various prior authorization requests, Careviso's audit delivers an insightful overview of operational challenges within the healthcare framework. Despite some cases transitioning smoothly through the system, significant hurdles remain. Over 75% of submitted requests received either approval or were found exempt from needing prior authorization, emphasizing the importance of detailed documentation and effective payor relationships.
However, almost 25% of cases faced denial, with many others requiring additional administrative follow-ups, thus complicating and prolonging the already time-sensitive clinical landscape.
Careviso's findings indicate that the average resolution time for most cases stands at around 5.5 days. While this is an improvement compared to industry averages, it still significantly impacts patient treatments, causing rescheduling of appointments and escalating stress amongst healthcare teams.
Among the most prevalent reasons cited for denials, the audit lists:
- Services provided were either unauthorized or not performed by network-approved providers.
- The rendering provider failed to furnish complete or accurate information.
- Certain procedures were classified as investigational or not covered under existing benefit plans.
These denials reflect a broader issue where even necessary care may be obstructed due to administrative discrepancies, policy limits, or inconsistent payer guidelines, ultimately affecting both providers and patients.
As healthcare financing increasingly shifts towards patients, there is a dire need for tools that alleviate administrative burdens. Careviso’s seeQer platform addresses this challenge by providing a streamlined, efficient prior authorization process, enabling healthcare providers to redirect their focus from paperwork to patient-centered care. Their system ensures secure connections to payers via strategic partnerships, thus supporting operational functions without direct interference.
Andrew Mignatti, CEO of Careviso, expresses, "Our commitment has always been to empower providers and facilities. We have created scalable technology aimed at automating and simplifying the prior authorization landscape. Achieving substantial growth while maintaining accuracy and transparency has been our hallmark."
While significant national discussions have revolved around healthcare cost transparency, Careviso’s audit highlights that administrative measures like prior authorization also necessitate comprehensive reform. Delays in receiving authorizations not only hinder care delivery but also undermine trust in the healthcare system, adding additional stress to an already complex health journey.
In the latest survey conducted by Careviso in April 2025, which encompassed 2,500 patients across the U.S., a striking 81% reported experiencing delays or disruptions in accessing care due to prior authorization requirements. Although movements toward more transparent legislation have been initiated, this latest data reinforces the notion that true advancements in healthcare transparency necessitate digital solutions that enhance operational efficiencies and cost clarity.
Careviso’s mission to revamp the prior authorization landscape spotlights support for providers rather than mere compliance with payers. The innovative seeQer platform provides real-time updates, fosters accuracy in documentation, and facilitates quicker resolution of authorization requests—thus granting labs and clinicians the confidence to deliver care without hesitation over administrative choices.
As the healthcare system progresses, Careviso remains dedicated to clarifying operations, guiding providers through payer landscapes, and remaining focused on a fundamental priority: ensuring high-quality, timely patient care.
About Careviso
Established in 2018, Careviso is committed to enhancing the healthcare experience by streamlining prior authorizations and emphasizing financial transparency. With a vision rooted in innovation and efficiency, Careviso assists healthcare providers and patients in untangling the complexities associated with accessing healthcare services and managing costs. To date, Careviso has efficiently processed over 2 million prior authorization requests and one million transactions related to financial transparency, reinforcing its reputation as a reliable partner in the healthcare sector.
Frequently Asked Questions
What does the Careviso 2024 audit reveal about prior authorizations?
The audit reveals significant inefficiencies and rising denial rates in the prior authorization process, indicating a need for focused digital solutions.
How long does it typically take to resolve prior authorization requests?
On average, most cases take about 5.5 days to resolve, which can still cause delays in patient care.
What are some common reasons for denial of prior authorization requests?
Common denial reasons include services being unauthorized, incomplete information from providers, and procedures being classified as investigational.
What solutions does Careviso provide to healthcare providers?
Careviso offers the seeQer platform, which streamlines the prior authorization process, focusing on efficiency and accuracy, allowing providers to prioritize patient care.
What is Careviso's mission?
Careviso aims to transform the healthcare experience by enhancing prior authorizations and financial transparency while empowering providers to concentrate on delivering quality care.
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