7 prior authorization updates

Here are seven prior authorization updates Becker's has reported since Nov. 6: 

1. UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division. The changes will take effect Jan. 1.

2. UnitedHealthcare and Cigna Healthcare are facing lawsuits from members or their families alleging the organizations use automated data tools to wrongfully deny members' medical claims. The allegations come amid broader ongoing conversations among policymakers around insurers' use of algorithms and artificial intelligence when processing claims or prior authorization requests.

3. The Indiana Legislature could tackle prior authorizations in its next session. The Legislature's Health Care Cost Oversight Task Force detailed recommendations for legislative proposals, and increasing transparency for prior authorizations and denials were among them.

4. Prior authorization is the most burdensome regulatory issue facing medical groups, with 89% saying it is very or extremely burdensome, according to a report from the Medical Group Management Association. 

5. Revenue cycle management teams will be thrust front-and-center as crucial to the the financial success of hospitals in an environment where health insurers are denying claims and delaying payments at a higher rate than before, Moody's Investor Services predicted for 2024. In recent months, insurers have doubled down on prior authorization requirements and have begun asking for extensive documentation before approving procedures. The additional resources needed to comply with private insurers' requests could be a drain on hospitals next year.

6. Blue Cross Blue Shield of Massachusetts' plan to remove 14,000 prior authorization requirements for home care services is a response to the capacity crisis in the state's hospitals, the payer's chief medical officer Sandhya Rao said. 

7. Baptist Health, based in Jacksonville, Fla., is using innovative approaches to streamline its staff's InBasket and prior authorization processes. 

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