There were more than 35 million prior authorization requests submitted to MA plans in 2021, and 2 million were denied, according to KFF. Of those denied, just 11% were appealed. However, most of those appeals led to the denial being overturned.
It’s time to stop thinking about prior authorizations as a transaction. Rather, PA is the start of a care episode that should be a smooth, well-coordinated journey for patients, their providers and their health plan.
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Remaining at or near the top of employers’ and consumers’ choices when it comes to health coverage will require insurers to make large investments in infrastructure, processes and people to overcome the status quo.
Less than 1% of hospitals and health systems said their relationship is improving and the rest said it has stayed the same. The American Hospital Association specifically called out commercial insurers for their practices on prior authorization and claims denials and delays.
The bill sets requirements relating to the prior authorization process for Medicare Advantage plans. The House's decision is supported by several healthcare advocacy organizations, including Better Medicare Alliance and the American Hospital Association. AHIP, however, neither criticized nor celebrated the passage.
Commercial insurers' practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications at AHIP.
The TSX Venture Exchange has a strong history of helping early-stage health and life sciences companies raise patient capital for research and development.
Geisinger Health Plan is licensing Cohere Health's AI-driven utilization management technology and services platform, designed to support value-based care delivery and streamline the prior authorization process.
Pharma companies often take the blame for high prescription costs. But a new, industry-sponsored survey shifts attention to insurance industry practices.
An intelligent authorization platform relies on AI and machine learning to extract patient-specific data from a number of sources including the EHR. This helps health plans better anticipate, manage and optimize member outcomes.
Insurers’ abuse of prior authorization is creating health risks for patients and contributing to higher downstream costs for both beneficiaries and the larger health care system.
This eBook, in collaboration with Care Logistics, details how hospitals and health systems can facilitate more effective decision-making by operationalizing elevated awareness.
To get to the root of existing reimbursement problems, health plans should consider tackling genomic benefits management in a way that addresses test ordering and billing challenges.
The bill, if enacted into law, will establish an electronic prior authorization process and require Medicare Advantage plans to report on their use of prior authorization and the rate of approvals or denials to CMS. It has 227 co-sponsors in the U.S. House, indicating strong support from both Republicans and Democrats.
Beginning July 1, Aetna now requires prior authorization for all cataract surgeries, across all its members and plans. Here in California and across the country, ophthalmologists are going to great lengths to secure approval from Aetna for cataract surgery, while the backlog caused by prior authorization and delayed elective care during the Covid-19 pandemic only grows.
It's time to embrace electronic prior authorization that, according to a 2021 AHIP study, has been found to reduce the mean time from PA request to decision by 69%. In addition, 71% of providers using ePA reported “faster time to patient care.”
The value of tech-enablement in a clinician’s day-to-day goes beyond our current outbreak scenarios. So much is still done by hand and faxed around that it screams of mid-90s nostalgia, but not in a charming way.