Blue Cross Blue Shield of MA eliminates 14,000 home healthcare prior authorizations, easing provider burdens and expediting hospital discharges. Starting Jan 1, 2024, services like physical and occupational therapy will bypass prior approvals. This step aligns with Blue Cross’s strategy to reduce authorizations—98% of claims are already exempt. Driven by industry shifts and CMS rules, this move reflects a broader trend, balancing care access and treatment efficacy across healthcare payers.
Between August and November 2023, significant payers like Blue Cross, Cigna, and UnitedHealthcare scaled back their prior authorization policies. Blue Cross, the most recent to announce changes, eliminated 14,000 prior authorizations for home healthcare services for its commercial health plan members.
Starting January 1, 2024, this new policy will affect prior authorizations for physical therapy, occupational therapy, and various home health services. The move aims to ease the strain on hospitals, freeing up inpatient beds by enabling faster discharges. Dr. Sandhya Rao, Blue Cross’s chief medical officer, emphasized this shift’s dual benefit: reducing administrative burdens on providers and enhancing patients’ transition from hospital to home.
The decision reflects Blue Cross’s ongoing strategy to streamline prior authorizations. Before this change, they had already eliminated prior authorizations for various medical supplies and treatments, aiming to ensure that most claims (98%) bypassed prior authorization requirements. They’ve also piloted automated prior authorizations, significantly reducing approval times.
While acknowledging the importance of prior authorizations in assessing treatment benefits and risks, Dr. Rao highlighted efforts to further streamline the process. This aligns with broader industry shifts, including CMS’s updated rule for Medicare Advantage plans and innovative approaches by other payers, like UnitedHealthcare’s Gold Card program and Health Care Service Corporation’s use of advanced technology to expedite prior authorization processes.
The landscape of prior authorizations continues to evolve, driven by a balance between facilitating care access and ensuring treatment effectiveness and cost control.