The Medical Group Management Association in Englewood, Colo., said it and 16 provider organizations set prior authorization principles aimed at trimming administrative burden associated with receiving approval from health plans, benefit managers and others to treat patients.
The 21 principles include five categories: clinical validity; continuity of care; transparency and fairness; timely access and administrative efficiency; and alternatives and exemptions. The coalition of provider organizations will aim to work with health plans and others to identify areas where the preauthorization process can be simplified.
Halee Fischer-Wright, MD, president and CEO of MGMA, said in a statement, "Despite the fact that the vast majority of prior authorization requests are ultimately approved, jumping through these administrative hoops can lead directly to delay or disruption in the delivery of care to the patient. Working together, the coalition has developed a landmark set of principles and I anticipate that this effort will translate directly into a reduction in the waste associated with prior authorization requirements."
Coalition members include:
- American Academy of Child and Adolescent Psychiatry
- American Academy of Dermatology
- American Academy of Family Physicians
- American College of Cardiology
- American College of Rheumatology
- American Hospital Association
- American Medical Association
- American Pharmacists Association
- American Society of Clinical Oncology
- Arthritis Foundation
- Colorado Medical Society
- Medical Society of the State of New York
- Minnesota Medical Association
- North Carolina Medical Society
- OhioState Medical Society
- Washington State Medical Society
This article was updated at 2:44 p.m. CT to reflect the American Medical Association is part of the coalition of provider organizations. We regret this error.