There is at least one reason to smile: Congress went home. While they are sipping lemonade during their traditional August recess, we are trying to figure out what is going on with the automation of prior authorization. In short, everyone agrees that we need faster decisions about what medical services health insurance will cover. There is little agreement about how to make this happen. On the one hand, Congress is proactively trying to accelerate prior authorization decisions with new legislation and urging CMS to finalize rules to make the process rely more heavily on technology. These activities were bolstered by a recent HHS OIG report that claims seven Medicaid managed care plans (Aetna, AmeriHealth Caritas, Anthem, CareSource, Centene, Molina, and UnitedHealthcare) are too often denying coverage requests. On the other hand, health plans are getting pushback — vilified in the press, investigated and sued, even — for using technology to make faster coverage decisions. So how are we supposed to move forward? It reminds us of a lyric in the song “Who Can I Turn To?” that Tony Bennett sang with Queen Latifah: “…maybe tomorrow I’ll find what I’m after.”
July 28, 2023 | 3 min read
July 28, 2023
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