Health care reform: standardizing insurer review procedures
Ch. 224 Section 207A – Simplification and modernization of utilization review procedures used by insurance companies.
The provisions included in this section reduce the administrative burden on health care professionals when requesting authorization for a treatment, test or therapy. Previously, physicians would be required to submit requests through separate and often confusing proprietary systems developed by each insurance company, creating a complex labyrinth of paper and electronic hurdles that created inefficiency and delayed care. The provisions passed under Ch. 224 require a shift to a uniform set of paper request forms, as well as ensure that emerging electronic technologies can be leveraged to further enhance the efficiency of the process. This is a huge win for both health care providers who bear the cost of the current administrative processes and patients whose care is less likely to be delayed or missed due to these hurdles. Additionally, patients will now be guaranteed that authorization requests are reviewed in a timely manner or the service will automatically be covered. Lastly, the groundwork for establishing electronic systems to access patients’ coverage information, another critical advancement for our business colleagues, providers and patients, was included in this section. These important enhancements to care delivery and patient protections are a direct result of the outstanding guidance and assistance provided by the government relations team at Donoghue Barrett & Singal.
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