Staying Up to Date on Payer Changes during COVID-19
May 28, 2020
Karis Volk, Content Marketing Specialist
The COVID-19 pandemic has brought many changes to the world of healthcare. Many of which were brought on by the desire to make things simpler and less time-consuming during a time where the phrase ‘all-hands-on-deck’ rings especially true.
With elective surgeries halted by COVID-19, practices are now flooded with backlogged surgeries, which may take up to 4 months to reschedule, according to CNBC. Payers are doing what they can to ease the prior authorization process by updating rules, modifying approval times, and offering manual extensions. However, rules are rapidly changing, and practices have scrambled to stay up to date.
Many national payers temporarily extended existing prior authorizations during the height of COVID-19. For example, for all authorizations with an end date or date-of-service between March 24, 2020, and May 31, 2020, United Healthcare provided an automatic 90-day extension. However, prior authorizations issued on or after April 10, 2020, were not eligible for the extension. United Healthcare also waived site-of-service reviews for nearly 2,000 surgery codes but is reinstating its standard policy on June 1, 2020.
Other payers waived prior authorization requirements altogether. Humana, another national payer, waived most prior authorizations and referrals non-COVID-related diagnoses, but just recently announced that beginning May 22, 2020, policies are reverting to standard.
And then other payers, like Aetna, only temporarily waived prior authorizations for post-acute care, but left other prior authorization requirements unchanged. And that’s just a sampling of national payers, not to mention regional and state insurance plans.
With so many different health plans out there, there is no one-size-fits-all set of rule changes. Meaning, health-systems will need to navigate the many modifications—taking time and resources and hurting already depressed revenues and patient care.
What if there was a one-size-fits-all solution to navigate all these rule changes?
With Verata Health’s Frictionless Prior Authorization® platform, providers can rely on artificial intelligence to prepare prior authorizations, identify payer rules, retrieve clinical documentation, and return payer decisions. So you don’t have to. With updates to payer rules throughout each day, Verata captures changes, like those made during COVID-19, so clinical staff doesn’t have to worry about tracking all of the modifications.
How Verata Works
Verata Health is the only prior authorization AI software solution that leverages powerful artificial intelligence to automate the prior authorization process from end-to-end. Verata Pathway’s artificial intelligence engine is integrated into your EMR workflows. With over 40,000 payer forms in its regularly updated database, Verata presents you with a fully completed prior authorization form and curated clinical documents for a complete prior authorization submission. Users can then use Verata to submit prior authorization to payers and track the submission to resolution. Managers have access to track every authorization as well as monitor productivity and throughput across all departments.
Verata is here to help. Don’t let the payer rule changes further delay your patients from getting the care they need. Get started with Verata today.