Health insurers move to streamline prior authorization process, promising quicker care
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Health insurers move to streamline prior authorization process, promising quicker care
Major U.S. health insurers say they want to make it faster and easier for patients to obtain care. They are taking steps to streamline “prior authorization,” industry jargon for the process by which health care providers obtain approval from patients’ insurance carriers to deliver care. According to a survey from the American Medical Association, physicians’ offices spend an average of 12 hours per week seeking approval for services from insurers. The real test will be the impact it has on the experiences of patients and physicians, an expert says. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans. It includes a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. The changes are scheduled to take effect in 2026 and 2027, the trade association says.
Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, announced Monday that some of its biggest members are taking steps to streamline “prior authorization” — industry jargon for the process by which health care providers obtain approval from patients’ insurance carriers to deliver care.
Prior authorization requests can be time-consuming for doctors, resulting in frustrating delays for patients in obtaining essential medical care. According to a survey from the American Medical Association, physicians’ offices spend an average of 12 hours per week seeking approval for services from insurers, administrative hurdles that critics say take time away from providing care.
As part of the new agreement, participating insurers have committed to a series of steps they say will speed up the sluggish process. That includes creating a standardized system for submitting prior authorization online, reducing the amount of claims subject to prior authorization and ramping up real-time responses to requests. Such changes are scheduled to take effect in 2026 and 2027.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” AHIP CEO Mike Tuffin said in a statement. “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement that the insurance industry initiative is a “step in the right direction,” but that the real test will be the impact it has on the experiences of patients and physicians.
Dozens of insurers signed onto the commitment, including a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans.
The signatories include:
AmeriHealth Caritas
Arkansas Blue Cross and Blue Shield
Blue Cross of Idaho
Blue Cross Blue Shield of Alabama
Blue Cross Blue Shield of Arizona
Blue Cross and Blue Shield of Hawaii
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Louisiana
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Michigan
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Nebraska
Blue Cross and Blue Shield of North Carolina
Blue Cross Blue Shield of North Dakota
Blue Cross & Blue Shield of Rhode Island
Blue Cross Blue Shield of South Carolina
BlueCross BlueShield of Tennessee
Blue Cross Blue Shield of Wyoming
Blue Shield of California
Capital Blue Cross
Capital District Physicians’ Health Plan, Inc. (CDPHP)
CareFirst BlueCross BlueShield
Centene
The Cigna Group
CVS Health Aetna
Elevance Health
Excellus Blue Cross Blue Shield
Geisinger Health Plan
GuideWell Mutual Holding Corporation
Health Care Service Corporation
Healthfirst (New York)
Highmark Inc.
Horizon Blue Cross Blue Shield of New Jersey
Humana
Independence Blue Cross
Independent Health
Kaiser Permanente
L.A. Care Health Plan
Molina Healthcare
Neighborhood Health Plan of Rhode Island
Point32Health
Premera Blue Cross
Regence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan Health
SCAN Health Plan
SummaCare
UnitedHealthcare
Wellmark Blue Cross and Blue Shield
Source: https://www.cbsnews.com/news/health-insurers-prior-authorization-blue-cross-cigna-united-healthcare/