The Medical Association of the State of Alabama(MASA) and BlueCross BlueShield of Alabama (BCBSAL) have announced progress in improving the prior authorization process.

Key changes underway:

• BCBSAL has not used AI for denials and is committed to future denial decisions not being made by AI.

• Less paperwork for chronic conditions. Once initially approved, BCBSAL will not require repeat prescription prior authorizations for patients with chronic conditions. A physician may be periodically asked to verify the continued need of the prescribed course of treatment.

• No surprise denials. An approved treatment or service will not be reversed if coverage is still active.

• BCBSAL offers a program that exempts physicians with a strong track record of prior authorization approvals from the standard process for certain services. BCBSAL will expand this initiative.

• Prior authorization will become fully electronic, allowing for instant approvals.

• If patients change BCBSAL plans, their existing prior authorization will remain valid for 90 days as long as the service is covered under the new plan with an in-network provider.

• Clearer rules: Patients and doctors will have access to a user-friendly platform that clearly shows which services require prior authorization and the associated criteria. Changes will be announced at least 45 days in advance.

Both organizations are continuing to collaborate on additional improvements.