Industry Progress on Improving Prior Authorizations

In a recent Medium post, Rachel Goldstein, Senior Manager at CAQH CORE, takes a look at the history of prior authorization and how we can move forward.

October 2019

A standard electronic method for conducting at least a portion of the prior authorization process has been federally mandated since the early 2000s. However, nearly 20 years later, 88 percent of prior authorizations are still conducted either partially or entirely manually, using faxes and phone calls to request and provide clinical information. When managed this way, prior authorizations can take hours, days and even weeks — leaving patients in limbo.

For providers, juggling the individual requirements and processes of each health plan is a significant administrative burden. On average, each manual prior authorization takes 16 minutes of provider staff time, while electronic prior authorizations take nine minutes to complete. And, because it may not be clear what documentation is needed at the time of submission, too often, requests are denied or delayed because of missing information. This results in a follow-up process that is daunting for all parties involved and can cause delays to patient care. The problem is so widespread that these old school processes add as much as $25 billion to the cost of US healthcare each year.

So, why is this process not automated?

Read the Medium post to learn more.

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