ONC Seeking Public Input on Electronic Prior Authorization Standards

On Jan. 21, the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) published a Request for Information (RFI) seeking public comments on certification standards for the development and implementation of electronic prior authorization IT products. Context: Payors rely on the prior authorization process to guard against utilization of medically unnecessary services. While designed to reduce waste and optimize care, the need to get a payor’s permission to deliver treatment creates administrative hassles and treatment delays. In 2020, ONC published a report outlining the main problems posed by prior authorization, including difficulty in determining whether an item or service requires prior authorization, inefficient use of provider and staff time to navigate communications channels such as fax, telephone and various web portals, and unpredictable and lengthy waits for payor decisions. With that in mind, IT developers have created products to help providers utilize their electronic health record (EHR) to navigate the prior authorization process faster and more efficiently. The ONC has created a certification program for IT developers to seek certification of their products. The new RFI proposes criteria that preauthorization IT products would have to meet to receive ONC certification. The comment period will last until March 25 and the ONC will consider the feedback for future rulemaking.