5 prior authorization updates

Here are five updates on prior authorization, Becker's has reported since June 18:

1. HHS' Office of Inspector General will audit Medicare Advantage plans' use of prior authorization in post-acute care settings. 

2. Blue Cross and Blue Shield of Rhode Island is eliminating nearly 65% of prior authorization requirements for primary care providers by early 2025. 

3. Leaders from Duluth, Minn.-based Essentia Health and York, Pa.-based WellSpan Health told Becker's why they are supporting legislation aiming to reform the Medicare Advantage prior authorization process. 

4. Humata Health, a company that uses AI and machine learning to streamline prior authorization for payers and providers, closed a $25 million investment. The funding was led by Blue Venture Fund (majority of BCBS plans) and LRVHealth (nearly 30 health systems and payers), with participation from Optum Ventures, .406 Ventures, Highmark Ventures and VentureforGood. 

5. Prior authorization is "wreaking havoc" on patient outcomes, physician burnout and productivity, according to a survey from the American Medical Association. 



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