AHA, AMA, payers urge CMS not to implement new electronic prior authorization standards 

The American Hospital Association, American Medical Association, AHIP and the Blue Cross Blue Shield Association are urging CMS not to move forward with implementing electronic transaction standards for healthcare attachments during prior authorization they say would create "costly burdens" across the healthcare industry.

In a July 27 letter to CMS Administrator Chiquita Brooks-LaSure, the four organizations wrote that while they appreciate the agency's work to reform prior authorization processes, "conflicting regulatory proposals" would cause widespread confusion and greatly increase expenses for providers and payers needing to comply with two sets of proposed standards. 

The groups noted that there have been major developments in prior authorization technology and regulations in recent years, including a CMS rule proposed Dec. 6 that would require federally regulated health plans to offer Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces to support electronic prior authorization. 

In contrast, a CMS rule proposed Dec. 19 would require a combination of both X12 and HL7 standards and apply to all health plans under HIPAA. 

"We are concerned by the conflicting provisions of these [rules] that would establish two different sets of standards and corresponding workflows to complete the PA process, depending on the type of health plan," the letter said. "Moreover, for federally regulated plans, this would require cross walking the two standards for no discernable benefit."

"For these reasons, our organizations strongly advise against adoption of standards for PA attachments as proposed in this rule," the groups concluded.

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