Measuring the Scope of Prior Authorization Policies: Applying Private Insurer Rules to Medicare Part B.

ABSTRACT:

Importance

Health insurers use prior authorization to evaluate the medical necessity of planned medical services. Data challenges have precluded measuring the frequency with which medical services can require prior authorization, the spending on these services, the types of services and clinician specialties affected, and differences in the scope of prior authorization policies between government-administered and privately administered insurance.

Objectives

To measure the extent of prior authorization requirements for medical services and to describe the services and clinician specialties affected by them using novel data on private insurer coverage policies.

Design setting and participants

Fee-for-service Medicare claims from 2017 were analyzed for beneficiaries in M

SUBMITTER: Schwartz AL 

PROVIDER: S-EPMC8796979 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature