ONC Wants Feedback on Electronic Prior Authorization Standards

The Department of Health and Human Services wants to know what health care providers and other stakeholders think about Electronic Prior Authorization, Office of the National Health Information Technology Coordinator. announced Friday.

ONC released information request about how its Healthcare IT Certification Program can include standards, implementation specifications, and certification criteria to advance electronic pre-approval.

“Supporting the needs of clinicians and improving patient care are key priorities for ONC,” Elise Sweeney Anthony, executive director of the agency’s Policy Office, said in a press release. “We are keen to hear from the public about prior authorization and ways to bridge the gap between administrative and clinical data so that clinicians have more time to focus on patient care and patients have a better experience with the healthcare system.”

The Prior Authorization Policy requires providers to obtain payer approval before prescribing drugs, performing procedures, or providing other services. Health insurers to tell these rules help control costs and reduce unnecessary services, while physicians and patients complain about the administrative burden and delays that pre-clearance can cause.

HHS encourages providers to submit pre-approval requests electronically, but while usage has increased over time, only 21% of health plans accepted digital requests in 2020, a CAQH indicator. survey found. Full transition to electronic pre-approval will save $417 million a year, a health insurance industry group predicts.

In December 2020, the Centers for Medicare and Medicaid Services published a proposed rule that would require Medicaid managed care programs and the Children’s Health Insurance Program, state Medicaid and CHIP agencies, and health insurance exchange plans to streamline the prior authorization process.

A proposed rule this year’s HHS regulation program will require Medicaid, CHIP, exchange plans, and Medicare Advantage operators to improve electronic health data exchange and simplify pre-authorisation.

The ONC is seeking feedback on a core set of capabilities that will enable certified systems to determine when pre-authorization is applicable, collect required documents, receive payer responses, and perform other functions. The ONC also wants comments on whether the Fast Healthcare Interoperability Resources implementation guidelines proposed in the previous rule are appropriate.

In addition, ONC asks stakeholders how potential changes to the certification program could impact patients, reduce vendor burden, place new demands on healthcare IT developers, and more.

The agency accepts applications until March 25.