On Tuesday, the Medical Association of the State of Alabama and Blue Cross and Blue Shield of Alabama (BCBSAL) announced progress in improving the “prior authorization” process, they jointly reported. 

Prior authorization is a tool insurance companies use to confirm that certain treatments, medications, or tests are clinically appropriate and covered under a patient’s health plan.

BCBSAL is a major health insurer in Alabama and sets the prior-authorization rules that many physicians must follow before certain tests, treatments, or prescriptions are covered.

The Medical Association represents Alabama physicians and has pushed to reduce administrative hurdles that can delay care.

Because most Alabama practices treat Blue Cross members, the two organizations have been meeting to simplify how prior authorization is handled across clinics and health plans.

While designed to provide coverage transparency and keep health care safe and affordable, the process can sometimes be challenging for patients and physicians.

Over the past year, the Medical Association and BCBSAL worked together to improve the system, and they report key changes are underway:

• Human review, not AI: BCBSAL has not used AI for denials and is committed to future denial decisions not being made by artificial intelligence.
  
• Less paperwork for chronic conditions: Once initially approved, BCBSAL will not require repeat prescription prior authorizations for patients needing treatment for chronic conditions. A physician may be periodically asked to verify the continued need and efficacy of the prescribed course of treatment. 
• No surprise denials: An approved treatment or service will not be reversed if coverage is still active.
• An “express lane” for trusted doctors: BCBSAL offers a “Gold Carding” program that exempts physicians with a strong track record of prior authorization approvals from the standard process for certain services. BCBSAL will work to expand this initiative.
• Enhancements of Online and real-time approvals coming soon: Prior authorization will become fully electronic, allowing for instant approvals. 
• Peace of mind when switching plans: If patients change BCBSAL plans, their existing prior authorization will remain valid for 90 days as long as the service is covered under the new plan with an in-network provider, to ensure their care isn’t disrupted.
• Clearer rules: Patients and doctors will have access to a user-friendly platform that clearly shows which services require prior authorization and the associated criteria. Changes will be announced at least 45 days in advance.

Both organizations emphasized they are continuing to collaborate on additional improvements, such as expanding the gold carding program and ensuring accelerated decision-making for patients.  

“This is about putting patients first,” the two organizations said in a joint statement.  “We are confident these enhancements will lead to better outcomes and less frustration for everyone involved.”

“Our goal is to make it easier for doctors to care for patients without unnecessary barriers,” said Dr. Mark LeQuire, president of the Medical Association. “These changes are a big step forward for timely care, especially for patients with chronic conditions.”

“We value our partnership with Alabama physicians,” said Dr. Darrel Weaver, Vice President Provider Engagement and Support, Blue Cross and Blue Shield of Alabama.

“These updates reflect our ongoing efforts to improve the member and provider experience while maintaining responsible stewardship of healthcare resources.”