The Centers for Medicare and Medicaid Services aims to overhaul health insurance prior authorizations under a propose rule published Tuesday.
The regulation would require Medicare Advantage, Medicaid and health insurance exchange carriers to ease their prior authorization processes and respond to “urgent” requests within 72 hours and standard requests within seven days. This would halve the amount of time Medicare Advantage plans currently have to respond to clinicians’ prior authorization requests, according to CMS.
Insurers would have to justify denials and publicly report data on their prior authorization decisions. Insurers and providers could also be required to implement technology that would allow patient health information to flow from one payer to another so that medical records would be available when policyholders change insurance companies.
“The prior authorization and interoperability proposals we are announcing today would streamline the prior authorization process and promote healthcare data sharing to improve the care experience across providers, patients and caregivers—helping us to address avoidable delays in patient care and achieve better health outcomes for all,” CMS Administrator Chiquita Brooks-LaSure said in a news release.
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