US insurer to change the approval process
Unitedhealthcare Signage will be exhibited on July 19, 2023 in an office building in Phoenix, Arizona.
Patrick T. Fallon | AFP | Getty pictures
Health plans within the framework of the major US insurers said on Monday that they voluntarily agreed to accelerate and reduce previous permits – a process that is often an important pain point in care for patients and providers.
The prior approval of the provider is approved by a patient's insurance company before performing certain services or treatments. Insurers say the process ensures that patients receive medically necessary care and enables them to control the costs. However, patients and providers have led earlier permits for delays or rejections and burnout of doctors in some cases.
Dozens of plans among large insurers such as CVS healthPresent UnitedhealthcarePresent CignaPresent HumanaPresent Surcharge And Blue Cross Blue Shield committed to a number of measures that aim to take care of the patients faster and to reduce the administrative burden for providers, as from a release from AHIP, a trading group that represents health plans. Although the companies cheered on the changes, they were able to reduce profits if they lead to patients using patients more often.
“The American health system has to work better for people, and in a statement in a statement we will improve it in a pronounced way that is really important,” said Steve Nelson, President of the insurer of CVS, Aetna. “We support the commitments of the industry to optimize, simplify and reduce the prior approval.”
The insurers will implement the changes in the markets, including commercial coverage as well as certain Medicare and Medicaid plans. The group said the improvements will benefit 257 million Americans.
The efforts include the establishment of a common standard for the submission of electronic earlier authorization inquiries at the beginning of 2027. Until then, at least 80% of the preparation permits for electronic authorization with all the necessary clinical documents will be answered in real time, according to the press release.
This aims to optimize the process and to facilitate the workload of doctors and hospitals, many of which still submit inquiries on paper and not electronically.
Individual plans reduce the types of claims that are subject to previous authorization requests by 2026.
“We look forward to working with the payers to ensure that these efforts lead to meaningful and permanent improvements in patient care,” said Shawn Martin, CEO of the American Academy of Family Physicians, in the press release.
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During an event on Monday, centers for Medicare & Medicaid Service Administrator Mehmet OZ thanked for insurance companies for “hiding”. He said the changes aimed at addressing three problems: timely access to the care of patients, the achievement of savings for the health system and the increase in transparency to the previous approval process.
At the event, the secretary said of health and human services, Robert F. Kennedy Jr.
The move takes place months after the US health insurance industry was confronted against a stream of public counter reactions after the top manager of Unitedhealthcare, Brian Thompson. It builds on work that several companies have already done to simplify their previous authorization processes.
Unitedhealthcare said in a statement, “welcomes the opportunity to join other health insurance plans in our joint commitment to modernize and rationalize the previous authorization process”.
The company stated to expand its previous efforts, including steps to reduce the number of services that require prior approval. It also includes the national gold card program from Unitedhealthcare, which recognizes and distinguishes providers that “consistently adhere to evidence -based nursing guidelines” by reducing your previous inquiries from the previous authorization inquiries.
