AHIP study finds electronic prior authorization may make it easier for providers to say goodbye to their fax machines

Providers who regularly use electronic prior authorization are largely finding that it speeds up patients' access and reduces time spent on administrative work like sending faxes, according to new data from America's Health Insurance Plans (AHIP).

AHIP kicked off its Fast Prior Authorization Technology Highway, or Fast PATH, project in early 2020. It recruited six major insurers—Blue Shield of California, Cambia Health Solutions, Cigna, Florida Blue, Humana and WellCare Health Plans, now part of Centene—and two technology partners, Availity and Surescripts, to participate in the analysis.

The study, conducted by RTI International, tracked 40,000 prior authorizations and surveyed 300 providers and staff members using electronic prior auth. The median time between submittinh a request and receiving a decision was three times faster using an electronic method, the study found, taking 5.7 hours compared to 18.7 hours for manual requests.

That represents a decrease of 69%, the survey said.

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Prior to using electronic prior authorizations, 17% of decisions were received in less than two hours. That number increased to 33% when electronic methods were introduced, the study found.

Twenty-four percent of manual requests took more than 48 hours before a decision was rendered, compared to 15% of those submitted electronically, according to the study.

Kate Berry, senior vice president of clinical affairs at AHIP, said during a briefing with reporters Wednesday that one of the goals of Fast PATH was to highlight insurers' commitment to helping providers take advantage of electronic prior auth.

She said the group hopes the results of the study can offer key lessons for future projects to grow electronic authorizations.

"It truly does take the entire ecosystem to make it work," Berry said.

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The analysis also found 71% of providers surveyed who used electronic means for most prior authorizations reported faster time to patient care. In addition, 54% of experienced providers reported fewer phone calls, and 62% said they spent less time on the phone.

More than half (53%) of experienced providers reported sending fewer faxes, and 63% said less time was spent sending documents via fax.

Denise Clayton, Ph.D., research economist for health economics and evaluation at RTI International, said during the briefing that while the providers participating in the study did conduct significantly more prior auth requests electronically, 38% were still submitted manually.

That finding highlights a need for future research on prior authorization—and suggests payers still have work to do in winning providers over, she said.

"Further gains could be realized by increasing provider adoption," Clayton said. "So we know that one way for providers to able to increase adoption is to have more payers and PBMs implement these solutions."