Prior authorization is a contentious issue between payers and providers, with payers arguing for its necessity to reduce costs and unnecessary care, while providers claim it creates administrative burden and delays care. Chris Severn of Turquoise Health and Don Antonucci of Providence Health Plan discussed prior authorization at a networking event. Antonucci mentioned that prior authorization serves to ensure patients get the right care and that systems between payers and providers are improving communication. While AI is being used to streamline the prior authorization process, there are concerns about its use in denying care requests. Calls for a national policy on prior authorization aim to standardize practices and improve the system overall. Both payers and providers agree that the prior authorization process needs improvement.
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Video: What Would Happen If Prior Authorization Went Away?
