16/04/2021

What Humana, Cigna & extra realized from yearlong prior authorization pilot

Success from a prior authorization pilot released by America’s Well being Insurance policies Options are in, and members noticed electronic prior authorization substantially shorten the time in between request and care shipping and delivery. 

In January 2020, AHIP, a single of the major trade groups for the health and fitness insurance plan field, debuted a prior authorization pilot that aimed to fast-observe the prior authorization course of action.

The Quick Prior Authorization Technological know-how Highway, or Quick Path, utilized automation software program from technology businesses Availity and Surescripts to digitize prior authorization procedures. 6 wellbeing insurers covering additional than 50 million People participated in the pilot: Blue Protect of California, Cambia Wellbeing Remedies, Cigna, Florida Blue, Humana and WellCare.

RTI Global independently evaluated 40,000 prior authorization transactions that took put during the 12-month pilot. The analysis uncovered companies employed the Rapid Path instruments for 62 percent of prior authorizations in the 6 months soon after applying the engineering. Inside that six-thirty day period period, the median time in between prior authorization submission and a decision from the wellbeing strategy was 3 moments quicker than in advance of the pilot, slipping from 18.7 hours to 5.7 hrs. 

Having said that, approval fees did not adjust. “This getting suggests that despite the fact that electronic prior authorization processes may well direct to faster periods to determination, the choices did not alter due to the fact the principles pertaining to prior authorization are the exact for manual and digital authorizations,” RTI Worldwide concluded.

Examine the full evaluation below.

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