Insurers Announce Voluntary Reforms to Streamline Prior Authorization

Major insurers have announced plans to simplify the prior authorization process, which has long been a source of frustration for healthcare providers. The process, which involves a cumbersome and time-consuming series of approvals, has resulted in billions of dollars in costs for providers and countless delays in patient care. Premier Inc, a leading healthcare company, has been at the forefront of advocating for change, citing data that shows claims adjudication costs providers nearly $20 billion annually and that over half of denials are ultimately overturned and paid after multiple rounds of review.

Key Takeaways:

• Major insurers have announced voluntary reforms to streamline prior authorization, a process that has long been criticized for being cumbersome and time-consuming.
• Prior authorization claims adjudication costs healthcare providers nearly $20 billion annually, according to data from Premier Inc.
• Over half of prior authorization denials are ultimately overturned and paid after multiple rounds of review, indicating a lack of efficiency in the current system.
• Premier Inc has been advocating for change and welcomes the insurers' announcement, but cautions that voluntary pledges are not the same as enforceable protections.
• Patients and providers deserve accountability and timely care decisions, according to Soumi Saha, Senior Vice President, Government Affairs, of Premier Inc.
• The proposed reforms, which include real-time approvals and honoring prior authorizations across plans, are seen as a step in the right direction, but more needs to be done to address the issue comprehensively.

Statistics:

• $20 billion: The annual cost of prior authorization claims adjudication for healthcare providers, according to Premier Inc.
• 50%: The percentage of prior authorization denials that are ultimately overturned and paid after multiple rounds of review.
• Multiple rounds of review: The number of times that healthcare providers must repeat the prior authorization process before being paid for a denied claim.
• Real-time approvals: The proposed reform that Would allow for instant approval of prior authorization requests.
• Fewer hoops: The proposed reform that Would simplify the prior authorization process for healthcare providers.

Sources:

• Premier Inc, "Premier Welcomes Announcements to Streamline Prior Authorization"
• June 23 (no specific year mentioned), Premier Inc.