Determine whether a patient needs a PA with eligibility verification & prior authorization software
Use seeQer’s eligibility verification and prior authorization software to determine if a PA is required for patient treatment. This is determined based on payor guidelines and datasets of standard medical codes, compared against intelligence from our proprietary databases.
Always know if a prior authorization is needed before treatment
When you know if prior authorization is required, you can reduce admin time, streamline patient care, and improve revenue—all while ensuring patients get the treatment or medication they need. Electronic prior auth software can help with that.
Delayed Treatment
If a patient needs a specialized medication or treatment, there can be delays to receiving it without having a prior authorization.
Prior Auth Requirement Visibility
seeQer electronic prior authorization software tells you whether a PA is needed before the patient can begin treatment, and states the likelihood of PA approval.
Unclear PA Requirements
Staff spend valuable time researching whether a prior authorization is needed for each service, leading to delays—especially for patients who need multiple services.
Automated PA Requirement Detection
seeQer’s electronic prior authorization software instantly determines if a PA is required based on payer guidelines and medical codes.
Missing Clinical Criteria
PA submissions are often denied and returned due to missing clinical details, causing rework and extending wait times during resubmission.
Complete Submission Requirements
seeQer validates that all required fields, attachments, and codes are present before a PA request is sent, reducing errors and approval delays.
Payer and Plan Variation
Each payer has unique rules and forms, making it difficult to consistently determine whether a PA is necessary.
Plan-Specific Policy Logic
seeQer automated prior authorization software normalizes payer policies and flags exceptions, ensuring accurate prior authorization eligibility checks every time.
Unclear Approval Odds
Teams lack insight into the likelihood of a PA being approved, making scheduling and patient communication challenging.
Approval Likelihood Indicators
seeQer uses historical outcomes and policy to provide an estimated likelihood of PA approval for informed decision making. Step therapy is also included when necessary.
Administrative Burden
Manually checking PA requirements for every patient adds administrative overhead and increases the risk of staff burnout.
Streamlined PA Eligibility
seeQer automates the PA determination process, freeing up staff to focus on patient care rather than administrative tasks.
Duplicate Prior Authorization Work
When a prior authorization has already been started by another provider or location, teams often don’t know, leading to duplicate submissions, wasted effort, and treatment delays.
Prior Authorization (PA) on File Visibility
seeQer’s PA on File feature flags when a prior authorization is already in progress and provides detailed information, reducing duplicate work and helping patients start treatment faster.
Manual Workflow
Search payer PDFs and websites for rules
Check plan requirements in payer portals
Research where to submit the PA
Cross-reference codes against payer policies
Update spreadsheets with PA requirements
seeQer Workflow
Rapidly detect whether a PA is required
See plan-specific rules for a PA
Automatically maps correct payer pathway for submission
View likelihood of PA approval by policy
Review PA requirement status in one place
seeQer prior authorization eligibility software is designed with healthcare transparency in mind
seeQer is compliant with all relevant industry requirements such as GFEs and HIPAA, maintaining strict requirements to protect patients’ health information. careviso is in current preparations to support clients with the upcoming requirements of the CMS Interoperability and Prior Authorization final rule.
How does seeQer determine if PA is required?
We map treatment codes to payer policies and plan-level rules, using proprietary datasets and continuous updates.
Can seeQer estimate approval likelihood?
Yes. We provide an indicator informed by policy fit and historical outcomes, which helps with scheduling and patient communication.
What if the payer changes its policy?
Policies are monitored and updated; you’ll see the latest guidance in seeQer’s workflow.
Does this replace clinical judgment?
No. seeQer is a tool that works alongside medical staff with policy intelligence and validation. Clinicians maintain decision-making authority.
Explore other seeQer services
That’s not all seeQer can do for you and your patients. Find out how additional features can provide more transparency, empower patients, and transform healthcare.
Patient Cost Responsibility
Receive coverage, cost, and prior authorization requirements based on insights from multiple databases.
Prior Authorization Eligibility
Automatically send your prior authorization to the operations team for processing when it’s required.
Prior Authorization Processing
Eliminate manual effort and cut down on admin time when your prior authorization is processed in real time.
Discover how seeQer informs patients and transforms practice.
Schedule a seeQer demonstration of benefits verifications, cost assessments, and other essential tasks in the platform. Learn how seeQer can help your organization reduce administrative burden, transform cumbersome processes, and provide transparency that empowers patients in a complex and ever-changing industry.