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Insurer Groups Join Effort to Ease Prior Authorization Nightmares

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Two big health insurer groups are teaming up with four big provider groups to try to improve U.S. health plans’ prior authorization procedures.

America’s Health Insurance Plans and the Blue Cross and Blue Shield Association have joined the effort together with the American Hospital Association, the American Medical Association, the American Pharmacists Association and the Medical Group Management Associations, AHIP announced today.

Health insurers and plans often require patients to check with them before getting certain types of care.

(Related: What Consumer Reps Wish They Knew About Health Plans)

Carriers that use prior approval programs say the programs can prevent fraud, waste and abuse, and, in some cases, keep patients from receiving care that may not be safe.

But “prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients, because the processes vary and can be repetitive,” AHIP says in its initiative announcement.

The six groups participating in the project say in a consensus statement that they want to reduce the number of health care professionals subject to prior authorization requirements and eliminating obsolete prior authorization requirements.

The groups say they want to streamline the prior authorization request process by pushing for adoption of national electronic document exchange standards, and by trying, whenever possible, to use existing standards, such as the standards pharmacies already use.

AHIP and the Blues agreed that their member insurers will try to do a better job of getting information about new coverage criteria and restrictions, and other new requirements, out to providers more quickly.

Insurers will try to rush coverage requirement updates out to providers by communicating better with electronic health record and pharmacy data exchange system managers, and by posting the information on websites aimed at providers.

A copy of the consensus statement is available here

—Read Employers Try to Rein in Specialty Drug Costs on ThinkAdvisor.

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