Medical association, BCBS reach prior authorization agreements

The state’s medical association and largest health insurer this week announced improvements to the prior authorization process needed before doctors can perform services or prescribe treatments.

The Medical Association of the State of Alabama and Blue Cross and Blue Shield of Alabama have been working to improve the process and make it more transparent, they said in a joint press release.

“Our goal is to make it easier for doctors to care for patients without unnecessary barriers,” said Dr. Mark LeQuire, president of the medical association. “These changes are a big step forward for timely care, especially for patients with chronic conditions.”

The organizations’ key agreements include:

• Denial decisions will not be made by artificial intelligence. The insurer said decisions have and will be made by people.
• Once initially approved, BCBSAL will not require repeat prescription prior authorizations for patients with chronic conditions. Physicians may be periodically asked to verify the continued need and efficacy of the prescribed course of treatment.
• An approved treatment or service will not be reversed if coverage is still active.
• Blue Cross will expand its “Gold Carding” program that exempts physicians with a strong track record of prior authorization approvals from the standard process for certain services.
• Prior authorization will be fully electronic, allowing for instant approvals.
• Patients and doctors will have access to a user-friendly platform that clearly shows which services require prior authorization and the associated criteria.

The association and BCBS will continue to discuss additional improvements, they said.

“We value our partnership with Alabama physicians,” said Dr. Darrel Weaver, BCBS’s vice president of provider engagement and support. “These updates reflect our ongoing efforts to improve the member and provider experience while maintaining responsible stewardship of healthcare resources.”