Providers, payers launch national 2-day prior authorization limit

Providers, health plans and vendors represented by the nonprofit organization CAQH voted to set a two-day limit on prior authorization requests, the group said Feb. 4.

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.

More articles on healthcare finance:
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CMS cuts payments to 786 hospitals over high rates of infection, injury
New York health system closes campus

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