HHS Aims to Simplify Prior Authorization Tasks

HHS proposed a new standard for attachments to support claims and prior authorization transactions.

HHS recently released a proposed rule that aims to standardize claims and prior authorization transactions under HIPAA.

According to the proposed rule, HHS seeks to adopt a set of standards for the electronic exchange of clinical and administrative data to support prior authorizations and claims adjudication.

In determining the necessity of a service as part of making a coverage decision, payers often require additional information that cannot adequately be conveyed in the specified fields or data elements of the adopted prior authorization request or claims transaction, the proposed rule said.

So, if this rule is adopted as proposed, the new standards would support electronic transmissions of this information, which would lighten the load for front-end revenue cycle staff by decreasing the amount of time and resource-consuming, manual processes used today to transmit this information.

This would facilitate better prior authorization decisions and claims processing, reduce burden on providers and plans, and result in more timely delivery of patient healthcare services, the rule said.

This is seen as a step in the right direction as the Medical Group Management Association's 2022 Annual Regulatory Burden Report says prior authorization requirements ranked as the top burden for providers.

According to the survey, 97% of respondents agreed that a reduction in regulatory burdens like this would allow their practice to reallocate resources toward patient care.

The AHA also echoed this sentiment and praised the HHS’ proposed rule.

The standard would apply to all providers who currently lack an efficient and uniform method of sending attachments, which can lead to provider burnout, slow down processing, and delay payments or patient care, the AHA said.

"The AHA supports establishing a standard for attachments to reduce the administrative burdens facing clinicians, and we look forward to providing robust commentary after analyzing the rule's specifics," Terrence Cunningham, AHA's director of administrative simplification policy, said in a release.