Cutting Red Tape: Three New Prior Authorization Forms

The Mass Collaborative, of which MHA is a founding member along with insurance companies and providers, last week had one of its prior authorization initiatives approved by the Department of Insurance (DoI).

DoI signed off on three new prior authorization forms relating to Hepatitis C medication, non-obstetric ultrasound, and Synagis (an FDA-approved prescription injection used to prevent certain lung disease).

Having a standard prior authorization form posted on DoI’s website or on the Mass Collaborative website cuts through the red tape of having individual forms from each insurance company with which a provider contracts. Chapter 224 requires DOI to develop and implement standard forms for all services requiring prior authorization.  Once fully implemented, these forms must be used by all providers and accepted by all Massachusetts licensed health plans.

There is a 90-day roll-out period for use of the paper version of the form, and a 6-month roll-out period for updates to any electronic version. Health plans and providers must begin using the paper version of the forms by December 11, 2017, and compliant electronic versions by March 12, 2018.