Decreasing Prior Authorization Response Times Depends on a Data-Driven Approach

Amidst the fallout of the Change Healthcare cyberattack, there's a critical need for streamlining prior authorizations to maintain claims payments. Even prior to the attack, over 90% of physicians faced delays in patient care due to the burdensome authorization processes, with rising complaints about coverage denials. Meanwhile, scrutiny mounts on health plans relying on AI for authorization decisions.

Despite industry acknowledgment of flaws, recent efforts by the Centers for Medicare & Medicaid Services aim to establish guidelines. However, prior authorization remains crucial for cost management. Payers are advised to adopt data-driven strategies to expedite responses, enhancing efficiency and patient outcomes.