Blue Cross and Blue Shield of Alabama and the Medical Association of the State of Alabama agreed upon changes to prior authorization, according to a Nov. 4 news release.
Over the past year, the insurer and the physician group collaborated on establishing shared goals with the prior authorization process.
Here are the seven commitments the groups outlined:
- BCBS of Alabama will not use AI for denials.
- The insurer will not require repeated prior authorizations for patients needing prescriptions for chronic conditions, while the provider will occasionally need to confirm use and efficacy.
- There will be no surprise denials for approved treatments and services.
- BCBS of Alabama will work toward expanding its gold-card program.
- Prior authorizations will go entirely electronic.
- Existing prior authorizations will stay valid for 90 days if a patient changes their BCBS of Alabama plan, so long as the provider is in network.
- Prior authorization changes will be shared at least 45 days before going into effect. Patients and doctors can access a platform that will outline which services require prior authorization, as well.
“We are confident these enhancements will lead to better outcomes and less frustration for everyone involved,” the organizations said in a joint statement.
