Blue Cross Blue Shield of Michigan Joins Insurers Across the Nation to Streamline and Simplify Prior Authorization Processes
Tricia Keith
| 3 min read
Tricia Keith is President and CEO of Blue Cross Blue...
We’ve been discussing the significant affordability challenges facing the health care industry in recent months, as well as the solutions we propose to make health care more affordable for our members and customers. Today, we’re pleased to announce an important industry commitment to address another significant pain point for some patients navigating the health care system – the prior authorization process.
Blue Cross Blue Shield of Michigan is proud to join the Blue Cross and Blue Shield Association and dozens of other insurers across the nation to pledge important changes to the prior authorization system. In partnership with the Blue Cross Blue Shield Association (BCBSA) and AHIP, a leading health insurance trade association, many insurers across the country have agreed to standardize, streamline and dramatically improve the systems we use to authorize some health care procedures and treatments.
Importantly, Blue Cross Blue Shield of Michigan has been ahead of the industry on several of these initiatives. In 2023, we announced our latest improvements, including reducing the number of treatments requiring prior authorization by 20%, and introducing an innovative “gold carding” program for providers and physicians, which waives many of the prior authorization requirements for physicians with a proven track record of evidence-based prescribing.
The industry commitments announced today are focused on six areas:
- Standardization. We will create and coordinate a common standard for submitting electronic prior authorization requests by the start of 2027.
- Reducing the scope. We will make sure the prior authorization practice is applied only where it needs to be.
- Continuity of care. Our commitment is to a 90-day period that covers patients if they received prior authorization with one insurer, then switch plans.
- Better support for members. We’re committed to communicating with you clearly, transparently and frequently throughout the prior authorization process.
- Expanding real-time responses. Because we realize you need the right information at the right time, we pledge that 80% of electronic requests will be answered in real time by 2027.
- People, not programs. Lastly, we promise we will ensure that prior authorization decisions are determined by people, and not artificial intelligence.
Blue Cross’ prior authorization program promotes quality and patient safety for members and provides assurance that the member gets effective care at the appropriate time. Each year, Blue Cross processes about 87 million claims. About 2%, about 2.5 million, go through the prior authorization process.
These improvements to the prior authorization process will help us create a more efficient and affordable health care system, while ensuring patients receive the most effective care, at a more affordable cost.
While we recognize that prior authorization is important to validate medical necessity and the appropriateness of services and prescriptions, we also recognize the process is far from perfect. We’re pleased to continue to improve the experience and access to care for our 5 million members and look for ways to improve the patient experience. But this is a great step in the right direction, because we know prior authorization should support the delivery of safe, effective and affordable care.
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