Prior Authorization Regulation: Facts & Future for Patients, Providers, and Payers

Hear informed perspectives on the scope and status of prior auth regulation at the state and federal levels.

Physician frustration. Patient economic worries. Staff burnout. Delayed care and adverse clinical events. All symptoms of prior authorization policy used and often abused to reduce healthcare costs and waste. Administering prior authorization policy even has an economic and reputation cost to insurance companies. There have been no clear winners in this decades-old battle.

Prior authorization dysfunction has recently grabbed the attention of state and federal policymakers who view it as an opportunity to help their constituents. Politicians see prior authorization regulation as a winning “kitchen table” issue that reduces economic risk for patients while enabling faster, simpler, less costly, and more effective healthcare for providers and staff.

Who Can Benefit

  • Patient Access and Revenue Cycle Management VPs, Directors, Managers
  • Information Technology VPs and Directors
  • Finance VPs and Directors

What You’ll Learn

  • Scope and status of prior authorization regulation at state and federal levels
  • Most common requirements of prior authorization regulation
  • How proposed and enacted regulation will benefit patients, providers, staff, vendors, and how it will change what they are each doing today
  • Regulation impact on prior authorization and retro authorization
  • Regulation that is viewed as “best-in-class” providing a model for others to follow

Dr. Steve Kim

Co-Founder & CEO

Michele Madison

Morris, Manning & Martin

Tim Holland

Director of People & Culture
The Wilshire Group

Evan Martin

Director of Advisory Services
The Wilshire Group