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National health care groups propose ways to cut 'preapproval' times

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Several national health care groups have collaborated on proposals to reduce pre-approval times for people who need to get pre-authorization from their health insurance carrier for a medical treatment.

The groups are the American Hospital Association, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association, Blue Cross Blue Shield Association and the Medical Group Management Association.

Those groups say that the process in which patients must get pre-approval from their insurance companies to pay for expensive medical treatments is cumbersome and time consuming for health care providers and insurance companies, and sometimes results in a denial of coverage.

In a consensus statement, those groups have pledged to work on:

  • Reducing the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider;
  • Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them;
  • Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes;
  • Protect continuity of care for patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements, and
  • Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

Tom Nickels, executive vice president of the AHA, said in a written statement, “These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden.”

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Vince Calio

Vince Calio

Vince Calio covers health care and manufacturing for NJBIZ. You can contact him at vcalio@njbiz.com.

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