10 Prior Authorization Updates in 2023

 



In 2023, various entities, including the Health Insurance Company and health Services Company, announced cuts in prior authorization protocols. Healthcare Media delved deeper into this, offering additional insights into the updates surrounding prior authorizations within the healthcare sector this year.

  1. A report released on November 13 by the Medical Group Management Association revealed that 89% of medical groups view prior authorization as an exceedingly cumbersome regulatory hurdle.

  2. CMS put forth proposed changes on November 6, focusing on health equity within Medicare Advantage organizations concerning prior authorization policies. These revisions aim to more effectively gauge any disproportionate impact on underserved populations, potentially leading to service delays or denials. These proposed modifications are part of a wider CMS rule set to take effect in the 2025 contract year. Feedback on this proposal is expected by January 5, 2024.

  3. Starting January 1, 2024, Blue Cross Blue Shield of Massachusetts plans to remove 14,000 prior authorization requirements for home care services for its 2.6 million commercial members. This policy extension will encompass Medicare Advantage members in 2025.

  4. On September 7, Blue Cross Blue Shield of Michigan declared a reduction of approximately 20% in its prior authorization requirements and an expansion of its gold-card program. The payer’s senior vice president and chief medical officer emphasized that these changes signify an ongoing evolution.

https://www.allzonems.com/10-prior-authorization-updates-in-2023/

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