Prior authorization plays an important role in helping ensure members get the right care in the right place at the right time.
But Health Care Service Corporation (HCSC) has taken a close look at the burden it sometimes brings members and their health care providers, Chief Clinical Officer Dr. Monica Berner says in this video interview.
HCSC has eliminated nearly 1,000 procedure codes from its clinical review process. The company also introduced innovative technology solutions that dramatically accelerate approvals and reviews by HCSC’s doctors and nurses.
“We are moving away from having to fax clinical information back and forth and having clinicians look at every single medical record, understanding that there’s a finite set of information that they’re always looking at when they look at medical records,” she says.