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Understanding

Pre Authorizations

Pre-authorization requests are becoming more prevalent in healthcare.
What is driving this process? How long has it been around?
And why is it so challenging?

Pre-authorization requests are increasing in frequency The steps to obtain prior authorization vary from insurer
due to genomic and esoteric testing becoming more to insurer, but typically involve the completion and faxing
mainstream. In response to the increased utilization, of a prior authorization form. 88% of the entire forms are
insurers are reacting by requiring prior authorization either partially or entirely manual, according to
checks to provide a cost saving to consumers by Wikipedia source. What is surprising, physicians have
preventing unnecessary procedures. Whether it is for historically been responsive to market changes by
the patients or the insurance company’s benefit is upgrading their technology stack to improve
debated by the AMA. workflow, according to the Council for Affordable
Quality Healthcare.
In 1996 HIPPA standardized the form for electronic
precertification called the ANSI 278 services authorization
called ePA for electronic prior authorization. Fast forward
23 years to current day, physicians experience an average
wait time from 1 to 3 days for prior authorization decisions,
source AMA.

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