Legislators aiming to streamline authorization process

In theory, Prior Authorization (PA) is a concept that seems straightforward and simple. But often times rules and regulations get in the way making it a cumbersome process that causes significant administrative burden on physicians and delays treatment for patients. During the last few years, many state medical associations have begun urging their local legislators to take action to improve and streamline the process; and the states have been listening.

15 states have proposed or enacted measures aimed at improving the efficiency of existing PA, or in some cases allowing electronic Prior Authorization (ePA) intended to better communication between patients, providers and payers. Iowa (HB 2463), California (SB 282), Virginia (SB1262) and Ohio (SB 129) are just a few instances where this is becoming the law and forcing payers and providers to take a closer look at their current processes and available options to meet or exceed these new standards.

To address these requirements, more providers are turning to portal solutions to ensure that they are in line with current legislation and to help their healthcare organizations provide a better experience to patients.

Robust provider portals allow for an improved workflow while eliminating the cost of paper, faxes, and phone calls by:

  • Providing an ePA through an on-line, cloud based system
  • Creating splash screens alerting that an Authorization has been approved or that there is a new authorization that needs attention
  • Meeting required turnaround times on PA requests and expedite urgent requests
  • Providing a streamlined appeals process in the event a PA is denied.

Keeping up with the fast-changing legislative landscape is a challenge all payer and provider organizations are facing. A better portal solution can help to navigate the healthcare eco-system to provide a more efficient process and a seamless user experience.

 


Mary Carol Morrissey is the Vice President of Health Plan Markets for Healthx. The Healthx collaboration platform connects payers, providers, and members to lower administrative costs, improve member health and manage the healthcare ecosystem.