Many health systems and patients have struggled with prior authorization procedures.
Prior authorization practices are staying in the spotlight. Health systems are looking for payers to do more to enhance the prior authorization process. While some health insurers have made strides, several states and health systems took matters into their own hands. From partnerships to policy reform, check out our five updates on prior authorization for payers.
- In April Humana expanded its partnership with Cohere Health’s prior authorization platform for diagnostic imaging and sleep services. We reported on this partnership last month, read the full coverage.
- A Kodiak Solutions report details that the final denial rate for inpatient claims in 2023 was more than 50 percent above the same rate in 2021.
- Vermont governor Phil Scott signs a prior authorization reform bill. Among the items in the legislation, it requires health insurers to decide prior authorizations within 24 hours for urgent situations and two business days for nonurgent care.
- At the start of this year Oregon-based St. Charles Health System partnered with insurer PacificSource to launch a pilot program to streamline automatic coverage approval for patients in need of cancer treatment.
- Oklahoma signed a bill into law that changes several prior authorization procedures including approval timelines. It also requires payers to have prior authorization procedures published on the company’s websites to be available for patients and providers
Marie DeFreitas is the finance editor for HealthLeaders.