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Biden Cracks Down on Prior Authorization

U.S. speeds up health insurer process used to authorize medical care
By Bruce Japsen

The Biden administration is streamlining - and in effect speeding up - the prior authorization process used by health insurance companies to approve medical procedures, surgeries and treatments.

Prior authorization has long been controversial because physicians and their patients see it as a way for health plans to deny doctor-recommended medical care without giving a good reason why or without providing a timely answer.

But the Centers for Medicare & Medicaid Services (CMS), directed by President Joe Biden’s appointees, says health plans need to respond to expedited prior authorization requests within 72 hours. Meanwhile, standard requests must be responded to within seven calendar days.

Under the final rule issued January 17 by CMS, health insurers that administer Medicare Advantage plans for seniors, Medicaid coverage for the poor, or individual coverage also known as Obamacare that is offered on public exchanges, must give a specific reason for denying a prior authorization request from a physician. Health insurers also will be required to report prior authorization metrics.

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