Best Practices for Prior Authorization

Top strategies for prior authorization

1. The process of prior authorizations can be painful. Accept that it will take time.

2. Assign a dedicated staff member (such as a medical assistant) to handle prior authorization requests, so as a dermatologist, you have more time with patients and more time to complete clinical documentation.

About 6 in 10 dermatologists report interrupting patient visits to handle prior authorization declines, sometimes even visits for surgery or procedures.

3. Frequently follow up with all parties to prevent delays and ensure the prior authorization is approved on a timely basis.

4. Use pre-populated forms, specifically the insurer’s forms, to minimize duplicated work and errors in providing information the insurer requires.

5. Use online tools and healthcare prior authorization programs to improve efficiency.

6. Reduce prior authorization wait times by having a comprehensive understanding of what prior authorizations entail, knowing insurance formularies and following prior authorizations all the way through approval.

More than half of offices use an automated prior authorization tool to reduce burden.

7. Document, document, document! You may need supporting clinical evidence on why you chose certain medications. The more information you have, the better chance you have at reducing delays.

8. Maintain a list or directory of medications and services that require prior authorization by different insurers. Check with your EHR vendor if these lists can be populated into the EHR, so an alert will appear if a prior authorization is required.

9. Create a process for each insurer. Outlining the steps it takes to do a prior authorization for each insurer will minimize time and burden in the future. (Check out the AAD’s sample workflow of how to do a prior authorization.)

10. Advocate! Ask Congress to reduce prior authorization burden.

11. If your request was denied, use the Academy’s prior authorization appeal tool. The appeal tool automates creation of a letter to appeal a denial for a prescribed treatment.

12. Be sure to also keep track of any denials and the time it took for the full process. Look for ways to improve the process.

13. As a last resort, if you are unable to get approval for a patient’s medication, you can always refer them to a drug pricing coupon for a discount. Check out the Academy’s drug pricing page for more information.

Related AAD/A resources