Introduction

Other payers, such as Blue Cross Blue Shield of Massachusetts and Florida Blue, are implementing strategies to reform their prior authorization systems. The U.S. House of Representatives passed a bill to reform the Medicare Advantage prior authorization process, and the Governor of Michigan signed a bill that shortens the time insurers have to consider prior authorization requests and provides more information about the process.

The rule is expected to improve patient access to care, reduce administrative burdens for clinicians, and support interoperability in the healthcare system. There are several solutions to improve the prior authorization process, such as automation, outsourcing, and collaboration between providers and payers.

Overhauling the prior authorization process is reaching its peak in state legislatures with 40 states expected to discuss measures simplifying doctors' process of obtaining health plan approval for procedures, tests, and treatments.

Importance:Asthecountryrecoversfromthe pandemic,SurgeonGeneralVivekMurthy andothersattributephysicianandhealth workerburnouttoadministrativeburdens suchaspriorauthorization.

Bidenadministrationproposedregulationsin Decembertoestablishanelectronicsystem andreducewaittimesforpriorauthorization inMedicareAdvantage,Medicaidmanaged careandAffordableCareActexchange plans.