Blue Cross Blue Shield of Alabama says it is reforming the process for getting prior authorization for insurance coverage of certain medical procedures and drugs – promising a simpler, more efficient system for patients and doctors.

The move in Alabama comes as insurance companies nationwide are making similar changes to their approval process, impacting a total of 257 million Americans.

“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system,” said Mike Tuffin, president and CEO of America’s Health Insurance Plans, the national trade association representing the health insurance industry.

Prior authorization is the process where healthcare providers must first get approval from a patient’s health insurance plan before providing certain treatments or medications.

Blue Cross Blue Shield of Alabama told AL.com they will implement a series of improvements to their prior authorization process, including:

• Affirming that unapproved clinical prior authorization requests will be reviewed personally by a licensed and qualified clinician.
• Making the process more transparent by ensuring communications to members about prior authorization are clear and contain personalized information including what is needed to support approval, next steps, and available appeal processes by 2026.
• Further reducing the use of prior authorization for certain in-network medical services by 2026.
• Ensuring a seamless process for members who switch health insurance companies by honoring their previous health insurance company’s prior authorization approvals for benefit-equivalent in-network services as part of a 90-day transition period, by 2026.
• Standardizing provider submissions for electronic prior authorization, giving doctors more time for patients by lessening the administrative burden by 2027.
• Fast-tracking responses for electronic prior authorization requests by answering at least 80% of requests in near real-time in 2027.

“Improving the prior authorization process will help us create an efficient, affordable, and sustainable health care system for Alabama,” Sophie Martin, a spokesperson for Blue Cross Blue Shield of Alabama said in an email. “Working together – with our provider partners and across health insurers – will ensure patients receive the most effective care, at a more affordable cost.”

The health insurance provider is the largest in the state, with 86% of the market share, according to the American Medical Association.

Blue Cross Blue Shield entities across the country have also signed on to the prior authorization reforms, along with providers like UnitedHealth, Humana and Cigna.

“These measurable commitments – addressing improvements like timeliness, scope and streamlining – mark a meaningful step forward in our work together to create a better system of health,” said Kim Keck, President and CEO of the Blue Cross Blue Shield Association. “This is an important foundation to address bigger problems together, at a time when technology and interoperability can deliver real improvements to patient experience.”