Nationally, Blue Cross and Blue Shield companies aim to improve the prior authorization process to make health care safer, effective and more accessible
As part of its mission to help members access quality, affordable health care, Blue Cross Blue Shield of North Dakota (BCBSND) announced today joining an industry-led commitment to simplifying the prior authorization process. Alongside other national insurance providers, BCBSND and other BCBS companies announced six commitments that will make the process faster, more seamless and more streamlined.
“BCBSND’s participation in these commitments reflects our continued efforts to strengthen our members' and providers' experience,” said Dan Conrad, BCBSND President and CEO. “In fact, BCBSND is already doing much of this work today. As an ongoing strategic priority, we are positioned well to meet or exceed the standards outlined in these national commitments.”
BCBSND has improved its prior authorization processes with a streamlined system and reduced the services requiring authorization to about 50. Providers can manage requests through an electronic portal and quickly verify needed authorizations with an online tool for accurate benefit quotes. BCBSND triages most requests within one business day, and responds with 48 hours, often exceeding URAC accreditation turnaround times. Appeals are reviewed by similar specialists or sent for external review if necessary.
As part of today’s announcement, BCBSND is further committing to:
- Standardizing provider submissions for electronic prior authorization, giving doctors more time for patients by lessening administrative burden.
- 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.
- Making the process more transparent by ensuring our 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.
- Fast-tracking responses for electronic prior authorization requests by committing to answering at least 80% of requests in near real-time in 2027.
- Affirming that licensed physicians personally lead reviews of unapproved prior authorization requests.
Improving the prior authorization process will help us create an efficient, affordable and sustainable health care system for everyone. Working together—across health insurers and with care providers—we will ensure that patients receive the most effective care, at a more affordable cost.
Resources:
- BCBS Perspective: Blue Cross and Blue Shield companies announce improvements to prior authorization.
About Blue Cross Blue Shield of North Dakota
BCBSND was founded in 1940 with the mission to provide members with affordable access to health care across the state. As an independent licensee of the Blue Cross and Blue Shield Association (BCBSA), BCBSND is committed to transforming care and health across the state to improve outcomes, lower cost trends and make it easier to shop, buy and use health care coverage. Members have access to unmatched local service and to a comprehensive network of health care providers across the state, the nation and more than 190 countries.
About the Blue Cross Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 33 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. For more information on BCBSA and its member companies, please visit bcbs.com.
About AHIP
AHIP is the national trade association representing the health insurance industry. AHIP’s members provide health care coverage, services and solutions to more than 200 million Americans. We are committed to market-based solutions and public-private partnerships that make high-quality coverage and care more affordable, accessible and equitable for everyone.
