Blue Cross and Blue Shield companies aim to improve the prior authorization process to make health care effective and more accessible
As part of its mission to help members access quality, affordable health care, Independence Blue Cross (IBX) announced today a series of improvements to the prior authorization process. Alongside other national insurance providers, IBX and other Blue Cross Blue Shield (BCBS) companies announced six commitments that will make the process faster, more seamless, and more streamlined in the future.
“At Independence Blue Cross, we are focused on the health and well-being of our members and customers. That’s why we have joined other health insurance plans in making these commitments to streamline, simplify, and reduce prior authorization processes. These efforts will help our members get the treatments and medical services they need more quickly and easily. They will also ease the administrative burdens on our network providers. The commitments also build on our existing work to improve prior authorization processes. In 2023, we launched an innovative program with Penn Medicine to simplify prior authorizations for outpatient scans. We have seen positive results from this program and are now expanding it to more providers in our network. We also expect our use of the Epic Payer Platform to further enhance and simplify these processes in the future,” said Dr. Richard Snyder, Independence Blue Cross executive vice president and chief operating officer.
As part of today’s announcement, IBX is committing to:
- Standardizing provider submissions for electronic prior authorization, giving doctors more time for patients by lessening administrative burden.
- Further reducing the use of prior authorization for certain in-network medical services by
- Ensuring a seamless process for members who switch health insurance companies by honoring their previous health insurance company’s prior authorization approvals for benefit-equivalent in-network services as part of a 90-day transition period, by 2026.
- Making the process more transparent by ensuring our communications to members about prior authorization are clear and contain personalized information including what is needed to support approval, next steps, and available appeal processes.
- Fast-tracking responses for electronic prior authorization requests by committing to answering at least 80% of requests in near real-time in 2027.
- Continuing to have licensed physicians review and issue any denials of care based on medical necessity.
Improving the prior authorization process will help us create an efficient, affordable and sustainable health care system for everyone. Working together—across health insurers and with care providers—we will ensure that patients receive the most effective care, at a more affordable cost.
Media contact:
Diana Quattrone
215-815-7828
Diana-Quattrone@ibx.com