Stakeholder group calls for 2-day limit on health care prior authorizations
As part of a greater push toward automation, CAQH CORE has voted to limit the time for prior authorization requests.
Good news for anyone who’s ever had to jump through the hoops of obtaining a prior authorization before they can get the care they need: health industry stakeholders are working to speed up the process by imposing a two-day limit on requests for supporting documentation.
Prior authorizations, a common tool for insurance companies to verify the appropriateness and quality of patient care, can often turn into a hassle for the patient, especially if the insurance company requests more information from a provider before they will approve the procedure.
Related: Use of electronic prior authorizations is increasing
CAQH CORE, a group representing health plans, providers and vendors, has voted to limit the time for such requests to two days. The rule will be adopted by all of its participating organizations, as part of a greater push toward automation.
“These industry-led efforts will benefit all stakeholders, and patients in particular,” said Tim Kaja, COO of UnitedHealthcare and CAQH CORE vice chair. “In 2020, CAQH CORE participants will continue working to improve the prior authorization process with a focus on how operating rules can streamline the exchange of medical documentation and support the use of new technologies with existing standards.”
Specifically, the new standard includes:
- Two-day additional information request: A payer has two business days to review a request from and respond with additional documentation needed.
- Two-day final determination: Once all requested information has been received, a response with final determination must be provided within two business days.
- Optional close out: The prior authorization request may be terminated if the additional information needed to make a final determination is not received from the provider within 15 business days.
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