prior authorization

Insurer Use of Prior Authorization Down

The insurance industry appears to be making good on its pledge to reduce its use of prior authorization for services and to make that process simpler for providers and patients Last June, some of the leading health insurers agreed to work to address prior authorization challenges. Now, an AHIP-Blue Cross Blue Shield Association survey has found that they have reduced by 11 percent the number of procedures and services that require prior authorization, which translated into 6.5 million fewer requests. Medicare Advantage plans went even further, eliminating 15 percent of procedures and services that require prior authorization. In addition, the [...]

joe2026-04-08T13:38:49-04:00April 10, 2026|Uncategorized|

States Stepping Into Prior Authorization Void

While federal lawmakers continue to weigh how to address the problem of prior authorization requirements that cause delays in the delivery of health care, many state governments are acting more decisively by implementing prior authorization reforms of their own. This year, 10 states have enacted 18 laws designed to facilitate prior authorization of medical services and in 2023, nine states and the District of Columbia did so. In all, 23 states have introduced prior authorization reforms in recent years. At the same time, some health insurers have reduced the number of medical services for which they require prior authorization. The [...]

joe2024-08-28T10:39:07-04:00August 29, 2024|Medicare|

Feds Tackling Prior Authorization

The Centers for Medicare & Medicaid Services has ambitious plans to improve the prior authorization process between providers and payers – and to save $15 billion over 10 years in the process. The tools it envisions using in its efforts include digitization, better data exchange, and streamlined prior authorization processes. It also will seek to foster greater transparency, requiring payers to be clearer about their policies and guidelines and to provide better explanations when they deny requests for care. Doing so, CMS believes, will reduce health care costs by $15 billion over ten years. Learn more about CMS’s prior authorization [...]

joe2024-03-21T21:31:16-04:00March 25, 2024|Centers for Medicare & Medicaid Services|

States Not Depending on Federal Action on Prior Authorization

Unwilling to leave the challenge of addressing the troubling prior authorization practices of many health insurers, officials in some states are trying to take matters into their own hands. Last year, lawmakers in 29 states considered 90 different bills to impose varying prior authorization requirements on health insurers serving their constituents. Among the changes these proposals seek: shorter response times for requests for authorization and mandatory public reporting of insurers’ prior authorization activity. In addition, last year five states required insurers to engage in a practice known as gold carding: waiving prior authorization for requested items and services for individual [...]

joe2024-02-13T16:56:53-05:00February 14, 2024|Uncategorized|

States Look to Take on Prior Authorization

The majority of states may act on insurer prior authorization practices in the coming year and even though the year is still only a month old, 16 states are already considering legislation to do so. The desire to act on prior authorization comes as providers continue to express dismay over delays in insurer review of the courses of treatment they seek to initiate for their patients, with some providers maintaining that those delays are jeopardizing the well-being of those patients. Insurers, meanwhile, insist that their reviews are necessary to ensure the health of their patients. In response to such expressed [...]

iqtsupport2023-01-30T06:00:53-05:00January 30, 2023|Uncategorized|