From Blue Shield of California partnering with Salesforce to a Senate report accusing Medicare Advantage plans of intentionally using prior authorization to boost profits, here are seven prior authorization updates Becker's has reported since Oct. 1:
1. EHR vendors Epic and Meditech are aiming to improve the prior authorization process in 2025.
2. Minnesota's Attorney General reached a settlement with Blue Cross and Blue Shield of Minnesota regarding accessibility of mental health services. As part of the agreement, the company agreed to make decisions about the vast majority of prior authorization requests for behavioral health services within five days.
3. Eighty-six percent of physicians said prior authorizations interfered with patient care, according to a Medscape Medical News survey.
4. Blue Shield of California is partnering with Salesforce on a new platform solution that aims to make prior authorization simpler and faster.
5. The largest Medicare Advantage insurers have prioritized profits over patient care by increasing the use of prior authorization in recent years to frequently deny post-acute care services to older adults, according to a report by the Senate Permanent Subcommittee on Investigations.
6. The American Hospital Association expressed opposition to parts of a new HHS interoperability rule aiming to facilitate better healthcare data exchange. The AHA said that while it supports prior authorization application programming interface certifications, the group said payers, like providers, should also have mandatory, rather than voluntary, standards to "ensure that protecting the privacy of patient data is prioritized."
7. UnitedHealthcare's national prior authorization gold-card program went into effect Oct. 1.