Dive Brief:
- Federal agencies plan to hold a series of events where payers, providers and health IT developers can test electronic workflows for prior authorization as the federal deadline for some insurers to automate the process looms.
- Hosted by the Office of the National Coordinator for Health IT and the CMS, the events will allow the organizations to test their software and identify gaps before a Jan. 1 deadline that requires health plans to support electronic prior authorizations.
- The testing events will last 10 to 12 weeks, and interested organizations must register with the CMS by Nov. 20.
Dive Insight:
Improving the prior authorization process has been a key focus for the Trump administration in its second term. On Jan. 1, some health plans, including Medicare Advantage, Medicaid managed care, Children’s Health Insurance Program and plan issuers on the federal exchanges, will be required to support electronic prior authorization.
The rule requires the payers to use four application programming interfaces, a set of protocols and definitions that allow software to communicate and share data.
Regulators say automating the prior authorization process will speed up care. Providers and patient advocates have increasingly maligned the process, which requires providers to get approval from insurance companies before performing some procedures. They say that prior authorization worsens patient outcomes and can exacerbate the healthcare affordability crisis.
In addition to the upcoming data rules, the Trump administration secured voluntary pledges from several major insurers to reform their prior authorization processes. The CMS is also trying to secure commitments from healthcare stakeholders to adopt electronic prior authorization. Sixty organizations have signed a pledge that they’ll work together to integrate electronic prior authorization.
