CAQH CORE aligns with push to boost prior authorization

A large not-for-profit organization is voicing its support for a nationwide initiative to improve prior authorization processes.

A large not-for-profit organization is voicing its support for a nationwide initiative to improve prior authorization processes.

CAQH CORE has endorsed a Consensus Statement from groups representing hospitals, physicians, medical groups, health insurers and pharmacists that launched an effort earlier this year to improve the often-lengthy prior authorization processes—also known as pre-approvals—that slow the delivery of treatment to patients.

The organization is a collaboration of more than 130 public and private health plans, hospitals and health systems, vendors and other stakeholders across the industry. CAQH CORE helps stakeholders adopt standardized electronic transactions and exchange data efficiently.

The support follows CAQH CORE’s efforts to reduce the burden of these administrative transactions on providers, insurers and patients.

Also See: Industry groups take aim at speeding the prior authorization process

“Substantially improving prior authorization on behalf of the industry ranks among our highest priorities in 2018,” its statement says. “Because prior authorizations have a significant impact on healthcare costs, administrative burdens, continuity of care and the patient experience, we have been working extensively to address this issue through CAQH CORE Operating Rules and CORE Certification.”

The Consensus Statement on Improving the Prior Authorization Process was issued in January by a variety of national healthcare organizations, including the American Hospital Association, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association.

The CAQH CORE letter highlights specific areas where it and the organizations that issued the Consensus Statement have shared goals, such as improved transparency and communications, continuity of patient care and greater automation and efficiency.

For example, Phase IV CAQH CORE Operating Rules set industry expectations for how prior authorization data is exchanged through requirements for response times, connectivity, acknowledgement of requests, and real time and batch processing. When finalized, Phase V CAQH CORE Operating Rules will ensure electronic prior authorizations contain critical information needed by providers and health plans to reduce the need for manual follow-up.

“We are greatly appreciative of the consensus statement authors’ commitment to this critical issue,” said Robin Thomashauer, CAQH’s president. “CAQH CORE participating organizations have spent considerable time developing ways to promote greater automation in the prior authorization process. We agree wholeheartedly with the consensus statement, and are eager to work together to make a difference.”

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