Prior Authorizations

Problem

When I joined Bright Health, nearly every prior authorization arrived the same way it had for decades: by fax. Someone at a provider's office would fill out a form, feed it into a machine, and our utilization management team would manually re-key everything into our systems.

At roughly $0.25 per authorization and over 2 million members, the math was painful. But the bigger problem wasn't the cost - it was that we were asking already-overwhelmed front office staff to add friction to their day so we could save money on ours.

Solution

Building a portal was the obvious solution. Getting anyone to use it was the actual challenge.

We sent researchers to observe front office staff submitting prior authorizations. What we found reframed the entire project: these staff members were already drowning in portal logins. Every payer wanted them to use a different system. But there was one place almost all of them went every day - Availity, the industry-standard clearinghouse that most major payers route through.

The insight wasn't "build a better portal." It was "don't make them learn anything new."

We integrated directly into Availity rather than competing for screen real estate. Our designers went back to those same provider offices to watch how staff actually entered authorization data - the sequence they followed, the fields they expected, the shortcuts they'd developed. We mirrored that flow exactly.

We piloted with a small provider group, iterated on their feedback, then expanded to the broader network.

Jared Stephens

Prior Authorization Portal

Killing the Fax Machine

My Role

Timeline

Team

Problem

Solution

Impact

Gallery

Prior Authorization Portal

Killing the Fax Machine

My Role

Timeline

Team

Problem

Solution

Impact

Gallery

Experience Screenshots

Personas