In an update to its list of codes requiring prior authorization, L.A. Care Health Plan has removed 24 percent of medical codes, including more than 50 percent of all laboratory test and radiology codes, the company announced Aug. 7.
The update was made after a review of historical utilization approvals to “help avoid delays in member care, speed up discharge requests, and decrease the administrative burden for providers,” the company stated in a press release.
In addition to 50 percent of all laboratory test and radiology codes, L.A. Care also removed most specialty care office visits, durable medical equipment, and catheter supplies from the list of services that require prior authorization. Certain services will always require authorization under the plan, including inpatient level of care, clinical trials, transplant surgery, unlisted procedures/codes, and noncontract providers.
In its announcement, the company cited the 2023 AMA Prior Authorization Physician Survey, which revealed the administrative burdens of prior authorization: 95 percent of physicians reported that prior authorization increases burnout and 94 percent reported delays in access to necessary care for patients.
“There is a place for prior authorization. It provides crucial timely information, ensures patient safety, and minimizes fraud,” John Baackes, L.A. Care CEO, said in a statement. “But L.A. Care understands that it shouldn’t be used as a cost-control mechanism, or as a way to delay or deny appropriate care.”
Sources:
https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
