Meaningful progress to improve prior authorization

Patients deserve safe, effective, affordable health care, and we’re committed to helping them access it.

Blue Cross and Blue Shield (BCBS) companies are making progress to streamline, simplify and reduce prior authorization, a critical safeguard to ensure care is covered, evidence-based and cost-effective. These improvements are part of a multi-year commitment made by nearly 60 health insurance providers that cover nearly 270 million Americans.

BCBS companies along with other leading health plans:

• Eliminated 11% of prior authorizations across a range of medical services, helping to speed access to evidence-based care.
• Extended previous approvals when a member switches insurance so care can continue uninterrupted, and
• Improved communications so patients better understand the process, decisions and their options.

“During the past 10 months, the Blues made significant, measurable strides toward delivering on our promise to make this process faster, simpler and more transparent,” said Kim Keck, CEO of the Blue Cross Blue Shield Association. “Moving forward, we will focus on our commitment to address 80% of electronic prior authorization requests in real-time, at the speed of care. We share CMS' urgency to modernize the infrastructure of health care and understand that all of us — policymakers, payers and care providers — have a role to play in activating change."

Improving an important step to balance access to care and costs

The vast majority of claims don’t require prior authorization, but it’s an important step for high-risk, high-cost care decisions. Prior authorization decisions are made by doctors, nurses and other clinically qualified experts and are guided by nationwide best practices for care, helping identify what has proven successful for members in the past. It makes sure treatments and procedures are covered, evidence-based and cost-effective, while ensuring every health care dollar is spent wisely.

BCBS companies committed to these improvements because we understand the process isn’t perfect, and that is why we’re reporting on our efforts to make prior authorization faster and more seamless.

See how BCBS companies are delivering on each commitment.