Medical Association and Blue Cross and Blue Shield of Alabama Announce Patient Centered Enhancements to Prior Authorization Process

MONTGOMERY – As we speak, the Medical Affiliation of the State of Alabama and Blue Cross and Blue Protect of Alabama (BCBSAL) introduced progress in enhancing the “prior authorization” course of.

Prior authorization is a device insurance coverage corporations use to substantiate that sure therapies, drugs, or assessments are clinically applicable and lined underneath a affected person’s well being plan. Whereas designed to supply protection transparency and hold well being care secure and inexpensive, the method can typically be difficult for sufferers and physicians. Over the previous 12 months, the Medical Affiliation and BCBSAL labored collectively to enhance the system.

Key adjustments underway:

• Human evaluation, not AI: BCBSAL has not used AI for denials and is dedicated to future denial selections not being made by synthetic intelligence.
  
• Much less paperwork for continual circumstances: As soon as initially authorized, BCBSAL won’t require repeat prescription prior authorizations for sufferers needing therapy for continual circumstances. A doctor could also be periodically requested to confirm the continued want and efficacy of the prescribed course of therapy.

• No shock denials: An authorized therapy or service won’t be reversed if protection remains to be lively.
  
• An “specific lane” for trusted docs: BCBSAL provides a “Gold Carding” program that exempts physicians with a robust monitor file of prior authorization approvals from the usual course of for sure providers. BCBSAL will work to increase this initiative.
• Enhancements of On-line and real-time approvals coming quickly: Prior authorization will grow to be totally digital, permitting for fast approvals.

• Peace of thoughts when switching plans: If sufferers change BCBSAL plans, their present prior authorization will stay legitimate for 90 days so long as the service is roofed underneath the brand new plan with an in-network supplier, to make sure their care isn’t disrupted.

• Clearer guidelines: Sufferers and docs could have entry to a user-friendly platform that clearly exhibits which providers require prior authorization and the related standards. Adjustments will likely be introduced a minimum of 45 days prematurely.

Each organizations emphasised they’re persevering with to collaborate on further enhancements, similar to increasing the gold carding program and guaranteeing accelerated decision-making for sufferers.

“That is about placing sufferers first,” the 2 organizations stated in a joint assertion.  “We’re assured these enhancements will result in higher outcomes and fewer frustration for everybody concerned.”

“Our aim is to make it simpler for docs to take care of sufferers with out pointless obstacles,” stated Dr. Mark LeQuire, president of the Medical Affiliation. “These adjustments are an enormous step ahead for well timed care, particularly for sufferers with continual circumstances.”

“We worth our partnership with Alabama physicians,” stated Dr. Darrel Weaver, Vice President Supplier Engagement and Assist, Blue Cross and Blue Protect of Alabama. “These updates replicate our ongoing efforts to enhance the member and supplier expertise whereas sustaining accountable stewardship of healthcare sources.”

Media Contacts

Jeff Emerson                                                                        Sophie Martin

jeff@dcwins.com | 205-540-2247 slmartin@bcbsal.org | 205-220-6816

Concerning the Medical Affiliation of the State of Alabama

The Medical Affiliation of the State of Alabama is the skilled group representing physicians of all specialties throughout the state. The Affiliation works to enhance public well being, help medical professionals and advocate for insurance policies that guarantee entry to high quality take care of all Alabamians. Go to www.alamedical.org for extra data.

About Blue Cross and Blue Protect of Alabama

Blue Cross and Blue Protect of Alabama has insured Alabamians for over 89 years. Blue Cross provides protection plans to firms, people and the senior market. For extra details about Blue Cross, go to AlabamaBlue.com. Join with us on Facebooktake a look at our movies on YouTube and comply with us on X for extra up-to-date data.

Blue Cross and Blue Protect of Alabama is an unbiased licensee of the Blue Cross and Blue Protect Affiliation.