Blue Cross and Blue Shield companies aim to improve the prior authorization process to make health care safer, effective and more accessible

As part of its mission to help members access quality, affordable health care, Blue Shield of California announced a series of improvements to the prior authorization process. Alongside other national insurance providers, Blue Shield and other Blue Cross Blue Shield companies announced six commitments that will make the process faster, more seamless and more streamlined.

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“Our members deserve safe, evidence-based, high-value care without delays. That’s why we’re committed to these prior authorization reforms to make the process faster, simpler and less burdensome,” said Mike Stuart, interim president and CEO, Blue Shield of California. “Blue Shield of California has been actively advancing in this direction through our Prior Authorization Reimagined initiative, which was introduced last year, and we are proud to be part of a broader movement.”

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As part of today’s announcement, Blue Shield is committing to:

  • Standardizing provider submissions for electronic prior authorization, giving doctors more time for patients by lessening administrative burden.
  • Further reducing the use of prior authorization for certain in-network medical services by 2026.
  • Ensuring a seamless process for members who switch health insurance companies by honoring their previous health insurance company’s prior authorization approvals for benefit-equivalent in-network services as part of a 90-day transition period, by 2026.
  • Making the process more transparent by ensuring our communications to members about prior authorization are clear and contain personalized information, including what is needed to support approval, next steps and available appeal processes.
  • Fast-tracking responses for electronic prior authorization requests by committing to answering at least 80% of requests in near real-time in 2027.
  • Affirming that licensed physicians personally lead reviews of unapproved prior authorization requests.

“Improving the prior authorization process will help us create an efficient, affordable and sustainable healthcare system for everyone,” said Stuart. “There’s real power in the Blues working together to move the industry forward, and these joint commitments reflect our shared determination to put members first while driving more affordable care.” 

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Source – PR Newswire