Prior Authorization Getting Much Needed Attention

February 2019

Prior authorization (PA) is a common source of frustration in healthcare. According to a recent survey from the American Medical Association, 28 percent of providers reported that the PA process has affected care delivery and led to a serious adverse event. Notably, 88 percent said the burden associated with prior authorization has increased over the last five years for their practice. And 86 percent indicated that the burden associated with PA in their practice was high or extremely high, requiring an average of nearly two business days per week.

According to the latest CAQH Index, little headway has been made by increasing use of electronic processes for prior authorization. This is partly due to an estimated 14 percent year-over-year increase in the number of prior authorizations nationally, and a 27 percent increase since the 2016 Index. While the use of fully electronic PA transactions increased four percentage points, the proportion of PAs conducted manually increased 16 percentage points from the last report.

2018 CAQH Index: Adoption of Electronic Prior Authorization, Medical
©2018 CAQH Index.

The Index reports that across the healthcare system, the medical industry could save $417 million annually by transitioning to electronic prior authorization transactions. Providers can realize most of these savings -- $278 million.

Improving PA Processes

CAQH CORE is steadily moving the industry towards simplified PA processes. Its PA vision: “Introduce targeted change to propel the industry collectively forward to a prior authorization process optimized by automation, thereby reducing administrative burden on providers and health plans and enhancing timely delivery of patient care.”

Find out more about CAQH CORE work to advance PA in their recent Town Hall webinar, and watch for updates in future Catalyst issues.

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