Why a ‘federal north star’ is needed for Medicare Advantage prior authorization

Becker's Healthcare June 27, 2024
Andrew Cass

Every year it feels like it’s getting harder and harder to work with Medicare Advantage plans, Essentia Health’s senior vice president of revenue services, Melanie Wilson, told Becker’s.

Duluth, Minn.-based Essentia is one of nearly 400 organizations backing recently introduced legislation aiming to reform the Medicare Advantage prior authorization process.

If passed, the bill known as the “Improving Seniors’ Timely Access to Care Act” would:

• Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
• Increase transparency around MA prior authorization requirements and its use.
• Clarify the HHS’ authority to establish timeframes for electronic prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and...

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