Prior authorization for imaging expedited under payer-provider partnership, study finds

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Prior authorization for advanced imaging requests was expedited when a health system used a clinical decision support tool in partnership with a commercial payer, according to a study published in the Journal of the American College of Radiology

The study concerned a partnership between an academic institution and a commercial insurer, which were unnamed. Under the partnership, the payer integrated a clinical decision support tool into the provider's EHR that used American College of Radiology criteria in the ordering process of outpatient CT and MRI scans.

Providers had a choice whether to use the tool. Providers used the tool for 15 percent, or 1,453, of outpatient CT and MRI orders. Of the orders, 69 percent had an expedited prior authorization process.

"Under specific circumstances, a commercially available CDS tool was used in partnership with a private payer and a radiology benefits management company to expedite prior authorization of outpatient advanced imaging examination orders deemed likely to be appropriate by multispecialty professional guidelines," the study concluded.

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