The North Carolina House of Representatives has passed a bill aimed at reforming the prior authorization approval process.
The bill requires payers to notify physicians within a specific timeframe if the medical necessity of a service is being questioned. It also mandates that payers publicly disclose a list of medical services requiring prior authorization review, and sets a 48-hour deadline for insurers to notify physicians and patients about nonemergency service approvals. Once all necessary information is submitted to the insurer, a decision on approval or denial must be made within that timeframe.
The bill also requires that denials be reviewed by North Carolina-licensed physicians in the same specialty as the requesting provider and with relevant experience.
The legislation passed the House on April 30 in a 109-1 vote. It now heads to the North Carolina Senate for further consideration, where it was referred to the Committee on Rules and Operations on May 1.
