Written by Jerred Ziegler.
Prior authorization is the process of ensuring a patient, or their health insurance provider, will be able to pay for a medical service before they receive it. This process is typically completed one of two ways: the physician staff can call the insurance company, which takes more than an hour on average, or the insurance company can fax the information they need. No matter the method, it’s a lengthy process that results in confusing communication between health systems and insurance companies. This is a problem Columbus, Ohio’s PriorAuthNow is working to solve.
“On average, a physician spends $65,000 each year obtaining prior authorizations,” said Joe Anstine, co-founder of PriorAuthNow. “The physician’s practice also spends around 20 hours a week fulfilling these requests. Our system cuts down on the time needed to submit prior authorizations to just 10 minutes, and cuts the amount of back-and-forth required between a physician’s office and the insurance provider in half.”
PriorAuthNow is a prior authorization solution made specifically for physicians and their staff. The company allows users to fill out one digital form for prior authorization, regardless of the patient’s insurance company. This standardization reduces the amount of time staff has to spend on prior authorization, and provides a dashboard so the status of each patient’s request can be tracked in one place.
Anstine started PriorAuthNow in July 2014 after a physician friend revealed his personal issues with analyzing whether or not a patient would be able to pay for their medical services prior to care. Anstine had started an analytics software company six years prior that provided data for Fortune 500 companies, and knew he could create a similar solution for health systems. He took the idea for PriorAuthNow to Rev1 Ventures, a central Ohio partner of Ohio Third Frontier, where he completed the organization’s Concept Academy.
“The whole point of Concept Academy is to gauge potential customers to see if you have a valid business idea. We distributed surveys to physicians all across central Ohio,” said Anstine. “What we discovered was that a majority of them were clamoring for a way to solve the prior authorization process to save their practices time and money.”
PriorAuthNow worked with Rev1 and OhioHealth on its initial round of funding, raising $200,000. The company used this funding to develop its prior authorization software and get it in the hands of test users in central Ohio. PriorAuthNow is currently working to raise an additional $500,000, with the further goal of raising a multi-million dollar seed round by the end of 2016.
“There is no way we’d be where we are today without the help of Rev1,” said Anstine. “I took the information we learned from Concept Academy to heart and found a product people care about. They have phenomenal advisers who have built companies similar to the one you’re trying to build, and they help you avoid the most common entrepreneurial mistakes.”
Anstine hopes to release PriorAuthNow to the general public in the first half of 2016. As of right now, he is working with his co-founder Amol Arora and a three-person development team to continuously add new features to PriorAuthNow. He anticipates adding an executive team to the company within the next nine months, and says the emerging startup scene in Columbus makes it the perfect place to grow his business.
“Columbus is our home, it’s where our partners, investors and customers are,” said Anstine. “This is a growing area, and we want to show other entrepreneurs across the country that Ohio has the resources you need to start a successful business.”