Prior authorization is an important tool to reduce unsafe, low-value, or inappropriate care. A recent HealthPayerIntelligence article highlights how health insurance providers are implementing electronic prior authorization and other tools to help improve the process for patients and clinicians alike.
In a survey of health insurance providers, 3 in 4 respondents are using electronic prior authorization to streamline prescription medication requests while nearly 90% are using electronic prior authorization to streamline medical services. Here are a few specific examples of how health insurance providers are improving prior authorization:
“Aetna made…changes to prior authorization for cataract surgeries in July 2022. The payer eliminated pre-certification requirements for most health plan members. … The health plan also ended prior authorization for physical therapy in Delaware, New Jersey, New York, Pennsylvania, and West Virginia.”
Health Care Services Corporation:
“…Health Care Service Corporation (HCSC)…has incorporated artificial and augmented intelligence into its prior authorization process. … The insurer expanded the use of an augmented intelligence tool that accelerates the prior authorization process up to 1,400 times faster. The tool streamlines the submission process and provides auto-approvals when certain criteria are met. The resource can triage and approve requests that require minimal information, allowing clinical staff to focus on reviewing more complex requests. … No prior authorization requests are denied using the tool—they are only approved or advanced to a hands-on review by an HCSC clinician.”
“Around 4 million Americans receive cataract surgery each year, and the procedure has a high success rate, improves quality of life, and is associated with reduced cognitive decline among older adults. …Humana has reduced care disruptions for Medicare Advantage beneficiaries in Georgia by eliminating its prior authorization requirement for cataract surgery….”
Read the HealthPayerIntelligence article.
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