Save time, money with Clear Coverage, coming soon for our providers

We know the prior authorization process creates additional tasks for you and your staff. This is why Providence Health Plans is working to decrease the impact to your practice in cost and time by implementing Clear Coverage, a fully automated Web-based system that offers useful tools to help you arrive at the appropriate medical decision. While prior authorizations continue to be a necessary part of managing health care costs, Clear Coverage has been shown to lower administrative costs by as much as 40 percent. Highlights of this new system include:

  • Automatic authorization: real-time for most requests
    • - Get immediate proof-of authorization while the patient is in your office
    • - Print confirmation with authorization number
    • - Submit requests online 24 hours a day, seven days a week
  • Clinical decision support: automated, interactive tool with InterQual® Criteria
    • - Confirm evidence basis for the requested procedure or find alternatives
    • - Verify if an authorization is required for specific types of procedures
    • - Print clinical evidence summaries for use in your practice
  • Integrated coverage determination: verify other aspects of patient’s insurance coverage
    • - Check eligibility
    • - Verify in-network servicing facilities
    • - Estimate patient payment (planned for future release)

 Representatives from Providence Health Plans’ Quality Medical Management and Provider Relations departments will be available for training as we develop our implementation plan.