As you may know, in April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. We’re excited that this legislation supports streamlining how we work with each other, making it easier for our members – your patients – to get the care they need when they need it.
Meeting PA 60 requirements
As a plan accredited by the National Committee for Quality Assurance (NCQA) and adherent to NCQA’s Utilization Management standards, we already meet a large portion of the PA 60 requirements. We’re on track to meet all other legislative guidelines on or before June 1.
Here are a few highlights we’d like to call out for you:
Reduced prior authorization turnaround times
Starting June 1, we’ll reduce turnaround times for non-urgent, standard prior authorization requests from 15 days to 9 days for our commercial, individual / ACA and governmental self-funded plans. Urgent requests will maintain the current 72-hour turnaround time.
Authorization requirement lookup tool
By June 1, providers will see a new tool available in prism. This tool will allow providers to look up a service’s prior authorization requirements and clinical criteria based on a member’s plan type – before submitting a request.
We’ll also enhance our authorizations quick reference list to include all services requiring prior authorization.
Member access to clinical criteria
On June 1, our members will have access online to a comprehensive list of services which require prior authorization and their associated clinical criteria, for the first time. They may reach out to their providers for help understanding the criteria.
We’re on track to meet all other legislative guidelines on or before June 1. For a detailed breakdown of PA 60 requirements and our health plan status, see our recent news item.