The purpose of this project was to review the current referral and prior authorization process and identify areas of improvement of the Financial Clearance, Outside Order Control position at Wentworth Douglass Hospital. The Outside Order Control role receives orders from practices not within Epic software, verifies the order, and passes on to the scheduling department. There was a need for this research at the hospital, as one of their main initiatives is to reduce prior authorization denials. Methods included shadowing and connecting with managers over equivalent departments at Mass General Hospital to determine differences between Wentworth Douglass and their processes. Areas of improvement identified were for staff to obtain authorizations for any orders missing required information, versus returning the incomplete paperwork to the ordering provider. In research, it was also determined that the hospital had the opportunity to register outside providers to an online portal to send orders directly into the Epic system.
A video recording of this presentation is available here.
College or School
College of Professional Studies Granite Division
Program or Major
Health Care Management
Eastman, Ashley, "Improving the Referral and Prior Authorization Process for Non-Health System Orders" (2022). M.S. in Health Care Management. 1.