Recent legislation in states like Texas and Michigan aims to ease the burden of prior authorizations on providers and improve patient experience by reforming prior authorization practices. While Texas legislation includes a “gold carding” system to exempt providers with solic track records from requiring prior authorization for specific procedures, Michigan legislation requires certain improvements from insurers across the board including implementing an electronic process for prior authorizations by June, 2023. Electronic prior authorizations have been the topic of discussion across agencies at the federal and state level for some time now. Indeed, in 2020, published a “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” which identified several problems with prior authorization including “inefficient use of provider and staff time to navigate communications channels such as fax, telephone, and various web portals” and “unpredictable and lengthy amounts of time to receive payer decisions.”
As a platform for prior authorization, SamaCare collects data across over 100 practices on both how prior authorizations are submitted and the average response time from payers to prior authorizations. To understand how electronic prior authorizations (ePAs), or the lack thereof, are impacting different specialties we took a look at all prior authorization submitted by practices on our platform in 2021. Looking across primarily retina, oncology, and neurology specialties, we found that less than 30% of prior authorizations are currently being submitted electronically.
The prevalence of ePAs compared to offline (e.g. fax) submissions varied by specialty for practices on our platform. Oncology practices, overall, submitted over 70% of prior authorization requests electronically, while retina and neurology lagged behind significantly when it came to percentage of prior authorizations that could be submitted electronically.
While approval rates for ePAs compared to offline prior authorization submissions were consistent, one important metric came to light in terms of the importance of electronic prior authorizations. When comparing the average time to prior authorization resolution between ePAs and offline submissions, we found that ePAs are resolved 69% faster than submissions that are faxed. ePAs, on average, saw a response time of under 24 hours while offline prior authorization submissions, on average, took nearly 3 days to see a response.
Of course, averages can be skewed by anomalous occurrences. For example, prior authorizations that get lost in the shuffle. At SamaCare, we refer to these anomalous prior authorizations as “wayward prior authorizations.” For the purpose of this analysis, we excluded prior authorizations that took 90 days or more to resolve. Given the average time to resolution for prior authorizations was still 69 hours, we then looked at what percent of prior authorizations submitted by form vs. portal took 3 days or more to resolve. Are just a few outliers skewing these numbers or do a significant percent of prior authorizations submitted by form take more than 3 days to resolve?
The answer is a substantial percentage of prior authorizations submitted by form take more than 3 days to resolve. Indeed, form submissions are over 150% more likely to take 3 days or more to resolve compared to portal authorizations.
The time it takes to secure approval for prior authorization impacts patient care, patient adherence to treatment regimes, as well as provider burden when it comes to tracking and following up on prior authorization submissions. For this reason, we encourage the ONC to consider time to approval and the digitization of prior authorizations interconnected and support their work to encourage the adoption of electronic submission across payers.
Recent legislation in states like Texas and Michigan aims to ease the burden of prior authorizations on providers and improve patient experience by reforming prior authorization practices. While Texas legislation includes a “gold carding” system to exempt providers with solic track records from requiring prior authorization for specific procedures, Michigan legislation requires certain improvements from insurers across the board including implementing an electronic process for prior authorizations by June, 2023. Electronic prior authorizations have been the topic of discussion across agencies at the federal and state level for some time now. Indeed, in 2020, published a “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” which identified several problems with prior authorization including “inefficient use of provider and staff time to navigate communications channels such as fax, telephone, and various web portals” and “unpredictable and lengthy amounts of time to receive payer decisions.”
As a platform for prior authorization, SamaCare collects data across over 100 practices on both how prior authorizations are submitted and the average response time from payers to prior authorizations. To understand how electronic prior authorizations (ePAs), or the lack thereof, are impacting different specialties we took a look at all prior authorization submitted by practices on our platform in 2021. Looking across primarily retina, oncology, and neurology specialties, we found that less than 30% of prior authorizations are currently being submitted electronically.
The prevalence of ePAs compared to offline (e.g. fax) submissions varied by specialty for practices on our platform. Oncology practices, overall, submitted over 70% of prior authorization requests electronically, while retina and neurology lagged behind significantly when it came to percentage of prior authorizations that could be submitted electronically.
While approval rates for ePAs compared to offline prior authorization submissions were consistent, one important metric came to light in terms of the importance of electronic prior authorizations. When comparing the average time to prior authorization resolution between ePAs and offline submissions, we found that ePAs are resolved 69% faster than submissions that are faxed. ePAs, on average, saw a response time of under 24 hours while offline prior authorization submissions, on average, took nearly 3 days to see a response.
Of course, averages can be skewed by anomalous occurrences. For example, prior authorizations that get lost in the shuffle. At SamaCare, we refer to these anomalous prior authorizations as “wayward prior authorizations.” For the purpose of this analysis, we excluded prior authorizations that took 90 days or more to resolve. Given the average time to resolution for prior authorizations was still 69 hours, we then looked at what percent of prior authorizations submitted by form vs. portal took 3 days or more to resolve. Are just a few outliers skewing these numbers or do a significant percent of prior authorizations submitted by form take more than 3 days to resolve?
The answer is a substantial percentage of prior authorizations submitted by form take more than 3 days to resolve. Indeed, form submissions are over 150% more likely to take 3 days or more to resolve compared to portal authorizations.
The time it takes to secure approval for prior authorization impacts patient care, patient adherence to treatment regimes, as well as provider burden when it comes to tracking and following up on prior authorization submissions. For this reason, we encourage the ONC to consider time to approval and the digitization of prior authorizations interconnected and support their work to encourage the adoption of electronic submission across payers.
Recent legislation in states like Texas and Michigan aims to ease the burden of prior authorizations on providers and improve patient experience by reforming prior authorization practices. While Texas legislation includes a “gold carding” system to exempt providers with solic track records from requiring prior authorization for specific procedures, Michigan legislation requires certain improvements from insurers across the board including implementing an electronic process for prior authorizations by June, 2023. Electronic prior authorizations have been the topic of discussion across agencies at the federal and state level for some time now. Indeed, in 2020, published a “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” which identified several problems with prior authorization including “inefficient use of provider and staff time to navigate communications channels such as fax, telephone, and various web portals” and “unpredictable and lengthy amounts of time to receive payer decisions.”
As a platform for prior authorization, SamaCare collects data across over 100 practices on both how prior authorizations are submitted and the average response time from payers to prior authorizations. To understand how electronic prior authorizations (ePAs), or the lack thereof, are impacting different specialties we took a look at all prior authorization submitted by practices on our platform in 2021. Looking across primarily retina, oncology, and neurology specialties, we found that less than 30% of prior authorizations are currently being submitted electronically.
The prevalence of ePAs compared to offline (e.g. fax) submissions varied by specialty for practices on our platform. Oncology practices, overall, submitted over 70% of prior authorization requests electronically, while retina and neurology lagged behind significantly when it came to percentage of prior authorizations that could be submitted electronically.
While approval rates for ePAs compared to offline prior authorization submissions were consistent, one important metric came to light in terms of the importance of electronic prior authorizations. When comparing the average time to prior authorization resolution between ePAs and offline submissions, we found that ePAs are resolved 69% faster than submissions that are faxed. ePAs, on average, saw a response time of under 24 hours while offline prior authorization submissions, on average, took nearly 3 days to see a response.
Of course, averages can be skewed by anomalous occurrences. For example, prior authorizations that get lost in the shuffle. At SamaCare, we refer to these anomalous prior authorizations as “wayward prior authorizations.” For the purpose of this analysis, we excluded prior authorizations that took 90 days or more to resolve. Given the average time to resolution for prior authorizations was still 69 hours, we then looked at what percent of prior authorizations submitted by form vs. portal took 3 days or more to resolve. Are just a few outliers skewing these numbers or do a significant percent of prior authorizations submitted by form take more than 3 days to resolve?
The answer is a substantial percentage of prior authorizations submitted by form take more than 3 days to resolve. Indeed, form submissions are over 150% more likely to take 3 days or more to resolve compared to portal authorizations.
The time it takes to secure approval for prior authorization impacts patient care, patient adherence to treatment regimes, as well as provider burden when it comes to tracking and following up on prior authorization submissions. For this reason, we encourage the ONC to consider time to approval and the digitization of prior authorizations interconnected and support their work to encourage the adoption of electronic submission across payers.
Recent legislation in states like Texas and Michigan aims to ease the burden of prior authorizations on providers and improve patient experience by reforming prior authorization practices. While Texas legislation includes a “gold carding” system to exempt providers with solic track records from requiring prior authorization for specific procedures, Michigan legislation requires certain improvements from insurers across the board including implementing an electronic process for prior authorizations by June, 2023. Electronic prior authorizations have been the topic of discussion across agencies at the federal and state level for some time now. Indeed, in 2020, published a “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” which identified several problems with prior authorization including “inefficient use of provider and staff time to navigate communications channels such as fax, telephone, and various web portals” and “unpredictable and lengthy amounts of time to receive payer decisions.”
As a platform for prior authorization, SamaCare collects data across over 100 practices on both how prior authorizations are submitted and the average response time from payers to prior authorizations. To understand how electronic prior authorizations (ePAs), or the lack thereof, are impacting different specialties we took a look at all prior authorization submitted by practices on our platform in 2021. Looking across primarily retina, oncology, and neurology specialties, we found that less than 30% of prior authorizations are currently being submitted electronically.
The prevalence of ePAs compared to offline (e.g. fax) submissions varied by specialty for practices on our platform. Oncology practices, overall, submitted over 70% of prior authorization requests electronically, while retina and neurology lagged behind significantly when it came to percentage of prior authorizations that could be submitted electronically.
While approval rates for ePAs compared to offline prior authorization submissions were consistent, one important metric came to light in terms of the importance of electronic prior authorizations. When comparing the average time to prior authorization resolution between ePAs and offline submissions, we found that ePAs are resolved 69% faster than submissions that are faxed. ePAs, on average, saw a response time of under 24 hours while offline prior authorization submissions, on average, took nearly 3 days to see a response.
Of course, averages can be skewed by anomalous occurrences. For example, prior authorizations that get lost in the shuffle. At SamaCare, we refer to these anomalous prior authorizations as “wayward prior authorizations.” For the purpose of this analysis, we excluded prior authorizations that took 90 days or more to resolve. Given the average time to resolution for prior authorizations was still 69 hours, we then looked at what percent of prior authorizations submitted by form vs. portal took 3 days or more to resolve. Are just a few outliers skewing these numbers or do a significant percent of prior authorizations submitted by form take more than 3 days to resolve?
The answer is a substantial percentage of prior authorizations submitted by form take more than 3 days to resolve. Indeed, form submissions are over 150% more likely to take 3 days or more to resolve compared to portal authorizations.
The time it takes to secure approval for prior authorization impacts patient care, patient adherence to treatment regimes, as well as provider burden when it comes to tracking and following up on prior authorization submissions. For this reason, we encourage the ONC to consider time to approval and the digitization of prior authorizations interconnected and support their work to encourage the adoption of electronic submission across payers.
