ONC would like feedback on electronic prior authorization standards


Department of Health and Human Services wants to know what providers and other stakeholders think about electronic prior authorization, Office of the National Coordinator for Health Information Technology Announce Friday.

ONC released a Request for Information About how its Health IT certification program combines standards, practices and certification standards to advance electronic prior authorization.

“Supporting the needs of clinicians and improving patient care are key priorities for ONC,” Elise Sweeney Anthony, executive director of the agency’s Office of Policy, said in a news release. “We are eager to hear from the public about prior authorization and ways to bridge the gap between administrative and clinical data so clinicians have more time to focus on patient care and patients have a better experience with the healthcare system.”

The prior authorization policy requires providers to obtain approval from payers before prescribing medication, performing procedures, or providing other services.health insurance company Say These policies help control costs and reduce unnecessary services, while clinicians and patients express frustration Administrative burden and possible delays due to prior authorization.

HHS encourages providers to submit prior authorization requests electronically, but even with increased adoption over time, only 21% of health plans accepted digital inquiries in 2020, CAQH polls established. The health insurance industry group estimates that a full transition to electronic prior authorization could save $417 million annually.

The Centers for Medicare and Medicaid Services released a proposed rule In December 2020, this will require Medicaid and Children’s Health Insurance Plan-managed care plans, state Medicaid and CHIP agencies, and the Health Insurance Exchange Program to streamline the prior authorization process.

One proposed rule HHS’ regulatory agenda this year will require Medicaid, CHIP, exchange programs and Medicare Advantage carriers to improve the electronic exchange of health care data and simplify prior authorization.

ONC requires feedback on a core set of capabilities that will enable certified systems to identify when prior authorization applies, collect necessary documentation, receive payer responses, and other capabilities. ONC also hopes to Rapid Healthcare Interoperability Resources The implementation guidelines presented in the previous rule are appropriate.

In addition, ONC asked stakeholders how potential changes to the certification program could impact patients, reduce burden on providers, place new requirements on health IT developers, and more.

The agency is accepting submissions until March 25.



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