David Allen, director of communications and public relations for AHIP, said, “AHIP has a wealth of prior authorizations and other tools,” and pointed to the survey results and other insurance industry reports.
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November 2023Kristine Grow, AHIP’s senior vice president of communications and public affairs, noted that AHIP “does not endorse any specific prior authorization platform for prior authorization.”
Annette Pham, MD, a facial plastic surgeon, otolaryngologist, and partner physician at The Centers for Advanced ENT Care’s Metro ENT and Facial Plastic Surgery division in Rockville, Md., said her surgery coordinator uses a variety of online platforms not tied into the electronic health records, so she needs to keep the usernames and passwords straight. But she said they are helpful.
“Information, including my office visit notes and even photographs, can be uploaded to their systems, which then generate reference numbers for my surgery coordinator to follow up on,” Dr. Pham said. “She can spend less time on the phone trying to answer questions.”
Her office also uses CoverMyMeds for prior authorization for medications, which is also useful, but more so when the pharmacy initiates the authorization.
“If the pharmacy staff doesn’t do it, then I have to enter in all the patient’s data and figure out which form for which medicine and which insurance to choose,” explained Dr. Pham. “The nice thing, though, is that in some instances, I can get approvals within minutes for some medications if I answer correctly.”
Heather Lisa, director of operations at ENT and Allergy Associates, said that using online platforms such as Availity and Navinet has been helpful for the most straightforward requests; she often gets an instant response.
“You hit submit, and you’re going to get that authorization,” she said. Her office has also developed proprietary tools to help assess which payments to collect and from whom, which can help the office’s overall processes.
An Unpredictable Process
This isn’t to say that prior authorization has become simpler over time—otolaryngology practices say that which treatments and medications will require prior authorization is is less predictable than ever and that more kinds of procedures require pre-approval every year. For example, they say they see more and more authorizations needed for septoplasty, turbinate reduction, or sinus intervention when there is clear imaging evidence of sinus disease.
“It’s a moving target because you never know what’s going to be subjected to prior authorization. Things that never needed pre-approval before sometimes all of a sudden pop up,” said Bradford Holland, MD, an otolaryngologist at Waco Ear, Nose & Throat. “It’s just an extreme variable that’s always a time suck for every level of your practice.”