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Blog | Operations and Other Technology

Healthcare stakeholders are invited to contribute suggestions for improving prior authorization

Blog | Operations and Other Technology

Healthcare stakeholders are invited to contribute suggestions for improving prior authorization

A two-month window is available to suggest electronic standards that would make the process more efficient.

The federal agency that oversees healthcare IT standards has issued a request for information (RFI) to stakeholders on ways to improve prior authorization.

The Office of the National Coordinator for Health IT (ONC) seeks input on “electronic prior authorization standards, implementation specifications and certification criteria that could be adopted within the ONC Health IT Certification Program.”

ONC notes that “payers and health IT developers have addressed prior authorization in an ad hoc manner with interfaces that reflect individual-payer technology considerations, payer lines of business and customer-specific constraints.” The hope is that improvements can be made through the certification program to address issues such as:

  • Confusion over whether an item or service requires prior authorization
  • Difficulty in determining payer-specific requirements
  • Inefficient use of time involving communications channels such as fax, telephone and various web portals
  • Uncertainty over the length of time needed to receive payer decisions

The voluntary certification program currently is used to enhance electronic prior authorization for medications but not for other items and services.

The agency hopes the RFI generates recommendations to build on approaches that have been outlined previously, including:

  • Leveraging health IT to standardize data and processes around ordering services or equipment
  • Coordinating efforts to advance new standards
  • Offering incentives to adopt or use technology that can generate and exchange standardized data to support documentation approaches

Read the RFI in the Federal Register and visit Regulations.gov to post comments by March 25.

About the Author

Nick Hut

is a senior editor with HFMA, Westchester, Ill. (nhut@hfma.org).

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