Home Industries Health Services BCBSRI to cut almost 65% of prior authorization requirements for primary care...

BCBSRI to cut almost 65% of prior authorization requirements for primary care providers

By

Katie Castellani

-

06/27/2024

BCBSRI — BLUE CROSS & Blue Shield of Rhode Island announced Thursday it will eliminate almost 65% of prior authorization requirements for primary care providers by early 2025.

PROVIDENCE – Blue Cross & Blue Shield of Rhode Island announced Thursday it will eliminate almost 65% of prior authorization requirements for primary care providers by early 2025. Prior authorization requires doctors to get approval from insurers before providing some medical services and is meant to make sure patients are receiving safe and appropriate care.

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PROVIDENCE – Blue Cross & Blue Shield of Rhode Island announced Thursday it will eliminate almost 65% of prior authorization requirements for primary care providers by early 2025. Prior authorization requires doctors to get approval from insurers before providing some medical services and is meant to make sure patients are receiving safe and appropriate care. However, prior authorization has also contributed to delays and inefficient care, frustrating providers and patients nationwide. BCBSRI says its decision to launch an initiative to cut back on prior authorization agreements comes after discussions with state regulators, members of the General Assembly as well as other health system stakeholders. "We recognize that prior authorization can be a significant source of additional administrative burden and stress for primary care providers at a time when PCPs are struggling," said Martha Wofford, president and CEO of BCBSRI. "We’re hopeful that reducing these authorizations, along with our significant investments in primary care practices, will help PCPs thrive and improve patient access to care as we continue to strive for balance between affordability for Rhode Islanders and stability for providers.” BCBSRI used data to identify some of the most common orders that create more work for providers. Reviewing the data will lead to lifting prior authorization requirements for several medical services, including radiology and cardiology, BCBSRI says. The initiative also aligns with the R.I. Office of the Health Insurance Commissioner, which issued a report in December showing prior authorization can “exacerbate burnout” of clinicians and called on insurers to “make significant reductions in the administrative burden” on providers. The insurer says it plans to continue streamlining its prior authorization in partnership with Rhode Island health care leaders and more details of the initiative will be shared with BCBSRI’s network of primary care providers and members in the coming months. Cory King, R.I. health insurance commissioner, praised BCBSRI’s initiative and said he hoped other insurers will do the same. “In recent years Blue Cross has been innovative and thoughtful in its approach to reducing the burden of prior authorization on health care providers,” King said in a statement to PBN. “I applaud Blue Cross for this action to materially reduce the burden of prior authorization on primary care providers in the state and I’m hopeful that other insurers will take note of this action and follow suit.” Point32Health Services Inc. is another insurer that announced updates to its prior authorization requirements for commercial services in April and expects to remove more in the coming months. Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.