Prior authorization comes at a big expense to the healthcare industry, both in administrative and delayed care costs. CAQH estimates prior authorization costs providers $631 million each year.
The new national two-day limit pertains to how quickly health plans have to request more information from providers to make a final coverage decision.
Under the two-day limit:
- A payer has two business days to review a prior authorization request from a provider and respond with more information
- A payer has two business days to send a coverage decision after all requested information has been received from a provider
- A payer can close out a prior authorization request if the additional information needed for the determination isn’t received from the provider within 15 business days of requesting more information
- The time frame requirements must be met 90 percent of the time in a calendar month
To view a full list of participants who agreed to this standard, click here.
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