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January 17, 2018 at 12:26 PM
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.
