We’ve just made pre-authorisation more efficient and transparent for plan members

For HMO plan members, pre-authorisation (PA) codes could be considered the gateways to healthcare access. They’re specially generated codes that enrollees can use to access care from any of the providers on the Reliance HMO provider network. Providers verify the PA codes and get approval from the Reliance HMO provider team before providing care to the enrollee. These codes are also used to authenticate and track the details of care given so that providers can be adequately compensated.

Pre-authorisations are a make-or-break moment for the patient experience. You want to know you’ve been approved for care quickly. And if there are any issues with approval, you want to understand why.

Digitising pre-authorisation for quicker access to care

Reliance HMO is working with our network of providers to eliminate pain points and create a smoother pre-authorisation process. We’re making the PA code request process digital, so there’s fewer risks of human error. No more data inconsistency, HMO ID errors or out of coverage requests. Providers no longer need to call us or send an email—they can make requests directly in our portal. That means fewer avoidable denials and quicker access to the care you need.

Increased transparency around denials

Digitised pre-authorisation not only reduces the risk of avoidable denials due to human error, it adds crucial transparency to the pre-authorisation process. By digitising PA code management, we’ll be able to give plan members key insights into their pre-authorisations every step of the way.

We’ll be able to send email or in-app push notifications providing much-needed context on the status of PA requests: the time taken for approvals or denials, and reasons behind partial or full request denials—so no one’s left in the dark about their care. To quote our SVP Clinical Services, Ugochi Nwosu: “Healthcare access shouldn’t be a black box. Efficient approvals are of utmost importance. But plan members should also understand why denials happen when they do. We’re proud to be working with providers to shed more light on our members’ healthcare journeys.”

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