Prior Authorization, also known as pre-authorization, has been around in health care for some time now. Medicare and Medicaid have long had prior authorization requirements for many services. Prior authorization has also been around for a long time for many procedures in allopathic care, think surgeries, etc….We are now seeing an expansion of the prior authorization process to physical medicine and complementary and integrative providers and the procedures that they provide. All that is to say…prior authorizations are here to stay. To read more check out WAC 284-43-0110 Health Carriers and Health Plans.
The massage therapy profession is not the only profession that is now being required to obtain prior authorizations on medically necessary services. Physical therapists, chiropractors, and acupuncturists, to name a few, require prior authorization. We are not being singled out. We actually are a very, very small group – a drop in the ocean. You can see some of the comments that were submitted by various health care providers and organizations on the OIC website: https://www.insurance.wa.gov/laws-rules/legislation-rules/proposed-rules/2016-19/comments/
The thing we do have input on is the process of obtaining prior authorizations and the rules that the Office of the Insurance Commissioner are creating around prior authorizations. The OIC proposed rule making CR102 request included this statement:
Purpose of the proposal and its anticipated effects, including any changes in existing rules:
In an effort to facilitate access to covered services, the Commissioner wishes to standardize the process of prior authorization when such a program is in effect. These rules are intended to streamline the prior authorization process and to ensure it is more transparent for consumers and providers.The rules require issuers to have online systems to process prior authorizations in a reasonable timeframe. The rules also provide other requirements for issuers to follow related to prior authorization
The OIC had meetings in 2016, to work on the language. We had representatives there at the meetings to learn about the process and provide input.
The OIC is most concerned with making sure that the prior authorization process does not delay or hinder treatment.
To assist massage therapists in dealing with the prior authorization process, WSMTA has created a best practices document on the process. We hope it will help you achieve optimal results with the prior authorization process.