New Law Prevents Delays Getting Prior Authorization Insurance Decisions

By PAULA TRACY, InDepthNH.org

Bạn đang xem: New Law Prevents Delays Getting Prior Authorization Insurance Decisions

CONCORD – Pursuant to a new law designed to streamline the process of getting permission for prior authorization of some health procedures, the state Insurance Department issued a bulletin Friday detailing the process for health insurers and related entities. 

The new law shortens the time allowed for health carriers to make decisions regarding prior authorizations, allows providers broader access to peer-to-peer review, and requires the Insurance Department to collect and disclose certain metrics relating to prior authorizations. 

“It is really a great reform initiative,” said Insurance Department Commissioner DJ Bettencourt in a phone interview.

Bettencourt stressed that the process to reach a compromise included lawmakers, insurance carriers, the New Hampshire Hospital Association, providers, his department and patients.

Xem thêm : Stuntwoman-turned-attorney accused of staging car crashes to file fraudulent insurance claims

“Ultimately there were incentives for all parties to insure the process works for patients,” Bettencourt said.

He said one of the provisions includes deadlines for decisions to be made about prior authorization.

If they are not met, the prior authorization is assumed to be automatically approved, Bettencourt said.

The department’s letter to insurers and other entities dated Jan. 2 said the bulletin is effective immediately.

The bulletin outlines essential standards and expectations for insurers, healthcare providers, and others engaged in the prior authorization process. 

“These updates are designed to address common challenges in obtaining timely authorizations, reducing administrative delays, and fostering clear communication among all parties involved in patient care,” according to the department.

Sponsored by state Sen. Denise Ricciardi, R-Bedford, the House of Representatives and state Senate both passed Senate Bill 561 last spring establishing criteria for prior authorization requirements by insurers of managed care benefits which was signed into law by Gov. Chris Sununu in June.

A copy of the bill is here 

Xem thêm : Luigi Mangione pleads not guilty in US health insurance company CEO murder – JURIST

“These updates reaffirm our commitment to ensuring that prior authorization processes do not serve as a barrier to essential healthcare services for Granite Staters,” Bettencourt said. “By refining these protocols, we aim to maintain the intended purpose of prior authorization: to prevent premium increases while supporting high-quality, efficient, and patient-centered healthcare delivery in our state.”

Key provisions include:

– Standardized time frames for decision-making to prevent unnecessary delays in care delivery.

– Improved documentation requirements to enhance the accuracy and completeness of authorization requests.

– Enhanced mechanisms for appeals and grievances to address denials of prior authorization requests.

The three-page bulletin is available at https://mm.nh.gov/files/uploads/nhid/documents/ins-25-001-ab-prior-auth.pdf. 

It notes the Insurance Department is in the process of rewriting administrative rules pertaining to utilization review to address these statutory changes. 

Reporter Nancy West contributed to this report.