From Texas' "gold card" rules taking effect to a Blue Cross Blue Shield of Massachusetts pilot program trimming approval wait times by more than a weekend, here are five stories about prior authorization that Becker's has reported since Sept. 14.
1. Blue Cross Blue Shield of Massachusetts said Oct. 12 that its artificial intelligence prior authorization pilot at Boston-based New England Baptist Hospital trimmed approval wait times by eight days.
2. Regence and MultiCare Connected Care said Oct. 11 they have launched the nation's first HL7 FHIR-based prior authorization system. The new interface will allow providers to submit prior authorization requests directly from MultiCare's EHRs — enabling faster determinations and reducing administrative burden and costs.
3. Nearly 82 percent of medical practices said prior authorization is very or extremely burdensome, according to an Oct. 11 report from Medical Group Management Association.
4. Texas' physician "gold card" rules went into effect Oct. 1. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services.
5. The House of Representatives unanimously passed a bill Sept. 14 to reform the Medicare Advantage prior authorization process. Among other elements, the bill would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denials. It would also require HHS to develop a process for "real-time decisions" on items and services that are routinely approved. The bill moved to the Senate for further consideration.