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New program to automate prior authorization review and approval


Program will use technology to speed the prior authorization process.

Prior authorization will become a speedier, more efficient process as part of a new program and initiative being launched by America’s Health Insurance Plans (AHIP), an insurer trade group, according to a news release.

The Fast Prior Authorization Technology Highway (Fast PATH) will use technology to improve connections between physicians and insurers. Despite modern technology, 46 percent of prior authorization requests are submitted by fax and 60 percent require a phone call. Fast PATH will rely on the Availity and Surescripts technologies to streamline prior authorization requests, responses, and information exchanges, the release says.

Insurers taking part in components of the program include Anthem, Blue Shield of California, Cambia’s affiliated health plans, Cigna, Florida Blue, and WellCare, which collectively cover more than 60 million Americans, the release said.

“When patients do better, we all do better,” Matt Eyles, president and CEO of AHIP, says in the release.  “Patients should receive the right treatments and medications at the right time in the most effective and efficient way. That’s why we’re committed to reducing unnecessary burden, increasing patient satisfaction and improving quality and outcomes.”

The program will improve the prior authorization process in prescribing medications, the release says, by putting critical information and processes at the doctor’s fingertips while the patient is still in the office through EHR, such as:

·      Giving physicians access to a patient’s pharmacy benefits, lets them know if a prior authorization is necessary, and gives information to choose an alternative treatment that is clinically equivalent but is more cost-effective or does not require prior authorization.

·      Immediately submit approval requests

·      Access to patients’ out-of-pocket cost for each drug

It will also improve the prior authorization process for medical and surgical procedures by allowing doctors and surgeons to access a multi-payer portal, simplifying requests and speeding up the process allowing for quality patient care by:

·      Informing physicians when prior authorization is needed

·      Allow them to easily submit the necessary information through a portal to fulfill the request

·      Enable the insurance provider the ability to review the information, make a determination, and send a response to the physician through the same portal

·      Health insurers can also manage all of the requests through a dashboard on the portal

The Fast PATH initiative will be advised by RTI International, an independent research organization, which will evaluate the improvements to the patient-provider experience after the pilot has run for six months.

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© National Institute for Occupational Safety and Health