{"id":8013,"date":"2023-04-06T06:51:32","date_gmt":"2023-04-06T06:51:32","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=8013"},"modified":"2023-04-10T18:19:35","modified_gmt":"2023-04-10T18:19:35","slug":"nine-updates-on-prior-authorization","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/nine-updates-on-prior-authorization\/","title":{"rendered":"Nine Updates on Prior Authorization"},"content":{"rendered":"

Recent updates on the prior authorization process include UnitedHealthcare’s plan to eliminate 20% of current prior authorizations and an AI-powered tool, GPT-4, that could potentially generate prior authorization requests. The American Hospital Association found that 94% of physicians face delays in patient care due to prior authorization, and the American Gastroenterological Association urged members to oppose new prior authorization requirements. Legislation backed by the Kansas Hospital Association and the Medical Group Management Association also called for prior authorization reform, while a survey from the American Medical Association found that 88% of physicians found it to be a large burden.<\/span><\/p><\/blockquote>\n

In recent years, the prior authorization process has been a major point of contention within the healthcare industry. The process, which requires healthcare providers to obtain approval from a patient’s insurance company before certain services or treatments can be provided, has been criticized for being time-consuming, burdensome, and often leading to delays in patient care. However, recent developments have brought new hope for reform to the prior authorization process. Here are nine updates on the prior authorization that Becker’s has reported since March 13.<\/span><\/p>\n

    \n
  1. AI-powered Tool for Prior Authorization Requests<\/span><\/li>\n<\/ol>\n

    On March 15, Peter Lee, Ph.D., corporate vice president of research and incubations at Microsoft, announced that GPT-4, an AI-powered tool built by OpenAI, could potentially be used to generate prior authorization requests. GPT-4 is an advanced natural language processing (NLP) tool that can be used to generate written text. The use of GPT-4 could potentially help to streamline the prior authorization process by reducing the time and effort required to complete prior authorization requests.<\/span><\/p>\n

    \u00a0 \u00a0 \u00a02. UnitedHealthcare’s Plan to Eliminate Prior Authorization Requirements<\/span><\/p>\n

    On March 17, UnitedHealthcare announced plans to eliminate 20 percent of its current prior authorizations and implement a national gold-card program. The gold-card program will be used to identify patients who have met certain criteria, such as having a history of compliance with recommended treatments or having a low risk of complications. Patients who meet these criteria will be exempt from certain prior authorization requirements.<\/span><\/p>\n

    \u00a0 \u00a0 \u00a03. Physician Survey Finds Prior Authorization Leads to Delays in Patient Care<\/span><\/p>\n

    On March 18, a survey from the American Hospital Association found that 94 percent of physicians reported that prior authorization led to delays in patient care and increased administrative burden. The survey also found that physicians spend an average of 14.9 hours per week on administrative tasks related to prior authorization.<\/span><\/p>\n

    \u00a0 \u00a0 4. American Gastroenterological Association Urges Members to Oppose New Prior Authorization Requirements<\/span><\/p>\n

    On March 22, the American Gastroenterological Association urged its members to contact UnitedHealthcare to stop new prior authorization requirements from going into effect. The new requirements would apply to certain gastroenterology procedures, including colonoscopies and upper endoscopies.<\/span><\/p>\n

    \u00a0 \u00a0 5. Kansas Lawmakers Consider Prior Authorization Reform Legislation<\/span><\/p>\n

    On March 24, Kansas lawmakers began considering legislation backed by the Kansas Hospital Association that would reform the prior authorization process. The proposed legislation would require insurance companies to provide more transparency and accountability in the prior authorization process.<\/span><\/p>\n

    \u00a0 \u00a0 6. Mississippi Governor Vetoes Bill Aimed at Speeding up Prior Authorization Process<\/span><\/p>\n

    On March 27, Mississippi Governor Tate Reeves vetoed a bill that aimed at speeding up the prior authorization process. The bill would have required insurance companies to respond to prior authorization requests within five business days for urgent cases and 10 business days for non-urgent cases.<\/span><\/p>\n

    \u00a0 \u00a0 \u00a07. American Hospital Association Urges CMS to Finalize Proposed Rule for Prior Authorization Reform<\/span><\/p>\n

    On March 29, the American Hospital Association urged CMS to finalize its proposed rule for reforming the prior authorization process. However, the organization suggested some changes to the proposed rule, including shortening the amount of time that the payers have to make a determination.<\/span><\/p>\n

    \u00a0 \u00a0 \u00a08. Medical Group Management Association Calls for Shorter Prior Authorization Time Frames<\/span><\/p>\n

    On March 31, the Medical Group Management Association said it wanted shorter prior authorization time frames when CMS finalizes its proposed reform rule. The organization also called for more prior transparency and consistency in the authorization process.<\/span><\/p>\n

    \u00a0 \u00a0 \u00a09. Physician Survey Finds Prior Authorization Requirements are a Large Burden<\/span><\/p>\n

    On April 3, a survey from the American Medical Association found that 88 percent of physicians say prior authorization requirements are burdensome and lead to worse patient outcomes. The survey also found that physicians spend an average of 14.4 hours per week on administrative tasks.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Recent updates on the prior authorization process include UnitedHealthcare’s plan to eliminate 20% of current prior authorizations and an AI-powered… Continue Reading <\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":8014,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-8013","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8013"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=8013"}],"version-history":[{"count":5,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8013\/revisions"}],"predecessor-version":[{"id":8064,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/8013\/revisions\/8064"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/8014"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=8013"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=8013"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=8013"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}