Major Health Coalition Forms to Streamline Prior Authorization Process
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A coalition of 29 major insurers, hospitals, and health records companies is forming to simplify the prior authorization process for medical treatments. The move follows a voluntary pledge by several top insurers last summer to improve the process across all health insurance markets. The initiative was highlighted by CMS Administrator Mehmet Oz at a recent health summit.
Facts First
- A 29-member coalition of insurers, hospitals, and health records companies is forming to simplify prior authorization.
- The effort follows a voluntary pledge by top insurers last summer to streamline the process across all health insurance markets.
- CMS Administrator Mehmet Oz recently highlighted the issue at the Axios Future of Health Summit and in a blog post.
- Traditional Medicare has historically not required prior authorization for most drugs or services.
- The administrative burden of prior authorization is a significant issue in privately run Medicare Advantage plans.
What Happened
A coalition of 29 major health care players is forming to simplify the prior authorization process for medical treatments. The initiative follows a voluntary pledge made last summer by several top health insurers to streamline and improve prior authorization across all health insurance markets. Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz highlighted the issue regarding the transition to electronic prior authorization.
Why this Matters to You
If you have private health insurance or are enrolled in a Medicare Advantage plan, this coalition's work could lead to less paperwork and faster approvals when your doctor recommends a treatment or medication. The administrative burden of prior authorization has been a significant source of frustration for doctors, which may have slowed down your care. A more efficient system could mean quicker access to necessary treatments.
What's Next
The new coalition will begin its work to simplify the prior authorization process, which may involve developing new standards or technologies. The transition to electronic prior authorization is likely to be a key focus. The voluntary nature of the insurer pledge suggests progress may depend on widespread adoption and cooperation across the industry.