What Humana, Cigna & more learned from yearlong prior authorization pilot

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Results from a prior authorization pilot launched by America's Health Insurance Plans are in, and participants saw electronic prior authorization significantly shorten the time between request and care delivery. 

In January 2020, AHIP, one of the largest trade groups for the health insurance industry, debuted a prior authorization pilot that aimed to fast-track the prior authorization process.

The Fast Prior Authorization Technology Highway, or Fast PATH, used automation software from technology companies Availity and Surescripts to digitize prior authorization processes. Six health insurers covering more than 50 million Americans participated in the pilot: Blue Shield of California, Cambia Health Solutions, Cigna, Florida Blue, Humana and WellCare.

RTI International independently evaluated 40,000 prior authorization transactions that took place during the 12-month pilot. The evaluation found providers used the Fast PATH tools for 62 percent of prior authorizations in the six months after implementing the technology. Within that six-month period, the median time between prior authorization submission and a decision from the health plan was three times faster than before the pilot, falling from 18.7 hours to 5.7 hours. 

However, approval rates didn't change. "This finding indicates that although electronic prior authorization processes may lead to faster times to decision, the decisions did not change because the rules pertaining to prior authorization are the same for manual and electronic authorizations," RTI International concluded.

Read the full evaluation here.

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