Prior authorizations consume hours of physician time as they seek insurer approval for drugs and treatments. Health plans say prior auths improve the quality of care and manage healthcare spending, but doctors say they infringe on their autonomy and take time away from patients.
According to CAQH CORE, an industry group representing health plans, providers, vendors and government entities, the number of prior auths increased 14 percent between 2017 and 2018. Although a federally mandated standard for automating part of the prior auth process has existed for more than a decade, only 12 percent of prior auths are automated.
Here are six factors that CAQH identified as barriers to end-to-end automation of prior auths.