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Prior Authorization

In January 2018, new state rules went into effect which attempt to ease the administrative burdens faced by physicians and practice staff making a good-faith effort to meet the numerous requirements of prior authorization programs used by Washington insurers.

The adoption of the rules marks the culmination of years of negotiation between the WSMA, the Washington State Hospital Association and the Office of the Insurance Commissioner, and represents a major victory in the WSMA's Healthy Doctors, Healthier Patients initiative.

The new regulations focus on streamlining and standardizing the programs for medical services used by health plans regulated by the OIC, clarifying definitions, setting timelines for standard and expedited requests, establishing clear communication requirements and much more. Similar OIC rules for prescription drug prior authorization programs passed in 2015.

The WSMA Prior Authorization Navigator

To help you adjust your workflow to accommodate the new requirements, the WSMA has introduced the Prior Authorization Navigator—a mobile-friendly “one-stop-shop” website for guidance on the new rules. On the Navigator, you'll find a one-minute bullet-point summary of the new rules as well as in-depth guidance on the rules’ provisions. You’ll also find guidance on 2015 rules covering prior authorization of prescription drugs.

Download a one-pager for quick reference for your staff or your office.

To enforce these new prior authorization requirements, the OIC is relying upon physicians and practices to report to the agency when insurers are out of compliance with the new rules. The WSMA Prior Authorization Navigator also features a complaint form designed to easily allow physicians and practices to send a message to the OIC when they encounter a problem.

The Navigator is designed to be your partner and protector during the prior authorization process. Keep the Navigator close at hand to quickly refer to the new requirements—and use it to send a message to the OIC each time you encounter a problem.

Visit and bookmark the WSMA Prior Authorization Navigator today.

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