New Jersey enacts new prior authorization requirements
Plus: BCBS NC's state health plan challenge can move forward
Good morning and happy Friday. Welcome to (this abbreviated version of) the Friday Pulse Check.
In the news:
HIPAA Violation of the Week: Humana sent PHI to the wrong address - Becker’s Payer Issues
Ron and I took some time on the FLATLINING Podcast this week to discuss the new CMS rule that requires certain response times for some prior authorization requests.
Prior authorizations, as I have heard from many physicians, are the bane of the insurance/physician relationship. As we have seen from several class action lawsuits as of late and from my own interview with the late Dr. Dan Hurley, incorrect denials and delays in responding can create significant barriers to patient care.
Check our podcast from this week:
Or listen on Youtube:
Now the state of New Jersey has new regulations for prior authorizations. Governor Phil Murphy signed these into law late last week:
If a prior authorization is denied, it must be denied by a physician of the same specialty that treats the condition or disease
If a patient was previously approved by a different health plan, his or her current health plan must cover the treatment for at least sixty days until they determine to continue covering it
Payers must respond to all prior authorization requests
Now of course, there is the conversation about an enforcement mechanism and what could happen if a payer decides not to play by these rules. We’ll keep looking into it an keep you posted here and on the FLATLINING Podcast.
Our own Ron Howrigon will be at the American Society of Anesthesiology conference in Las Vegas, Nevada this weekend. If you happen to see him, say hello and let him know you’re a reader of the Friday Pulse Check.
The Detroit Lions are taking on the San Francisco 49ers this weekend for the first time in most of our lifetimes. The game will be at 6:30pm on FOX.
Have a good weekend,