January 1, 2018
Prior authorization, one of the most burdensome administrative requirements faced by medical group practices, is the focus of a collaborative of leading healthcare organizations, including MGMA. The group released a joint statement in an effort to address some of the most pressing concerns associated with prior authorization.
Consensus Statement on Improving the Prior Authorization Process
Our organizations represent health care providers (physicians, pharmacists, medical groups, and hospitals) and health plans. We have partnered to identify opportunities to improve the prior authorization process, with the goals of promoting safe, timely, and affordable access to evidence-based care for patients; enhancing efficiency; and reducing administrative burdens. The prior authorization process can be burdensome for all involved—health care providers, health plans, and patients. Yet, there is wide variation in medical practice and adherence to evidencebased treatment. Communication and collaboration can improve stakeholder understanding of the functions and challenges associated with prior authorization and lead to opportunities to improve the process, promote quality and affordable health care, and reduce unnecessary burdens.
The following five areas offer opportunities for improvement in prior authorization programs and processes that, once implemented, can achieve meaningful reform.