With CAQH CORE’s recent announcement of the Two-Day Rule to accelerate the Prior Authorization Process, the industry leaped forward in breaking down barriers to timely patient care. As NantHealth discussed in our whitepaper How to Ease Administrative Burdens, Boost Billing Accuracy & Speed Payments, turnaround time, and supporting documentation are two critical aspects of today’s typical prior authorization workflow that can delay review and approval and impact patient care.
Under the new Two-Day rule, payers are expected to request additional documentation within two days of receiving an authorization request and return a final determination within two days of having all necessary inputs. The benefits of this will be felt not just by providers who need greater transparency into the status of their authorization requests, but also by patients who are dependent on these requests being reviewed and approved before treatment can be scheduled.
The industry is rising to the challenge of streamlining prior authorization workflows, with CAQH CORE and the Davinci Program at the forefront of defining practical standards and providing valuable implementation guidance. However, broad and consistent adoption of technology standards and best practices can take years, especially for complex workflows like prior authorizations, where the HIPAA X12 278 Healthcare Service Review transaction standard leaves gaps in the necessary information. FHIR standards (Fast Healthcare Interoperability Resources) Specification, which is a standard for exchanging healthcare information electronically, are still emerging, and many smaller provider practices may not have the technical wherewithal to implement these solutions.
Creating transparency and enabling self-service or automation for providers throughout the prior authorization lifecycle, resulting in the reduction of phone calls, faxes, and manual intake processes and greater collaboration with payers is top-of-mind for us at NantHealth. NaviNet Open Authorizations, part of NaviNet’s broad product portfolio, allows payers to request additional information and push status updates to providers. The notification features built into the NaviNet platform ensures providers and their staff know when something needs to be addressed, or an authorization has been approved. Our user interface makes it easy to upload the necessary documentation or look up the details about authorization status.
Implementing these solutions does not require a heavy lift to modify electronic data exchange (EDI) data content for the payer and provides the opportunity to reach every provider, large and small, tech-savvy or not. NaviNet can provide a blueprint for health plans to support the Two-Day Rule. As more organizations adopt standards, you can rest assured that our platform will evolve to support deeper integration, interoperability, and automation.
We applaud and support CAQH CORE and participating organizations in their continued commitment to streamlining healthcare workflows. Since 2005, CAQH CORE has been helping the healthcare industry uniformly adopt electronic transactions and exchange data efficiently by facilitating multi-stakeholder collaboration among more than 140 organizations – providers, health plans, vendors, government agencies and standard-setting bodies – to define operating rules that support data exchange standards, accelerate interoperability, and align administrative and clinical activities among providers, payers, and consumers. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author of operating rules for HIPAA administrative healthcare transactions.