As the customer’s patient volume grew, teams struggled to keep up with prior-authorization status checks. Slow visibility into decisions and recurring “need-info” loops led more patients to abandon therapy before their first fill. To cut time-to-therapy and prevent renewal drop-offs, the enterprise needed a way to scale operations and close information gaps in near real time.

Asepha partnered with the client to implement a whitelabeled, enterprise call automation layer across their call centers. Beginning with high-volume payors, real-time phone endpoints were set up and rolled out in phases.

Outbound PBM/PSP Call Automation (PA Status)

• Dials payers, navigates IVRs, waits on hold, authenticates from case data.
• Captures decision + next steps (submitted/pend/approved/denied/need-info) with structured notes (rep, ref#, timestamp).
• Returns outcomes to HUB/CRM and triggers tasks for missing items (labs, chart notes, prior therapy).

Proactive SMS for Missing Info & Renewals

• Two-way SMS to collect required docs, confirm details, and nudge prescribers/patients.
• PA renewal reminders (and copay/PAP re-enrollment) to prevent avoidable lapses.
• Escalation rules for sensitive or non-responsive cases.

Ops & Governance

• Dashboards: abandonment at PA stage, median time for Rx→PA decision, % “need-info” resolved <72h, 90-day persistence by cohort, renewal capture.
• PHI/consent management, transcripts/audit logs, tenant-level branding & templates.

Reduced PA-Stage Abandonment
Faster status retrieval and immediate info collection reduced pre-start abandonment by 26%

Faster Time-to-Therapy
Shrinking “pending” time and closing info gaps accelerated Rx → PA decision by ~1–2 days.

Higher Early-Cycle Persistence
Earlier starts and fewer administrative stalls drove a +3–5 point lift in 90-day persistence.

Operational Efficiency
Teams reclaimed an average of ~24 min/case from eliminated hold time and simpler documentation. This time was redirected to appeals prep and complex cases.

Actionable Insights
Dashboards exposed payer-specific choke points (e.g., repeat “need-info” causes, long-hold plans), enabling targeted fixes and improvements over time.