In its June 23 press release entitled, “Insurer inaction on prior authorization reform requires federal response,” the AMA laments the lack of progress being made by payers in 5 key areas:
Selective application of requirements
Adjustment of the volume of requirements
Protection for continuity of patient care
Automation through standardized processes
Mettle has developed solutions for three of these key areas:
1. Improved transparency. The AMA reports that 67 percent of physicians report that it is difficult to determine whether a drug or service requires prior authorization. Mettle has developed a solution called Documentation Requirement Lookup Service (DRLS) that allows payers to display to physicians – right in their EHR, right at the time of service – whether the patient’s health plan requires prior authorization for the item/service the physician is contemplating for the patient.
2. Protection for continuity of patient care. The AMA survey found that 83 percent of physicians report that prior authorization interferes with continuity of care, such as interruptions in chronic treatment. Mettle’s Medical e-Prior Authorization (MePA) FHIR service allows providers to electronically send MePA requests and include supporting documentation directly from the electronic medical record. Providers can also track the status of outstanding requests and receive responses from payers from a single interface. In addition, Mettle has developed a solution called Payer Transition Information Exchange (PTIE) that allows an outgoing payer to share with an incoming payer all active treatments the patient is currently receiving to promote continuity of care for patients.
3. Automation through standardized processes. The AMA believes that efforts should be made to speed the adoption of existing national standards for electronic transactions for prior authorizations but find that physicians still report phone and fax as the most commonly used methods for completing prior authorization requirements. Mettle’s MePA FHIR service was built on the Da Vinci FHIR standard called Prior Authorization Support. In addition, the Mettle service gives health plans the ability to receive the prior authorization transaction in either a) FHIR format, or b) 278 format.
Mettle is currently accepting payer applications for inclusion in the Mettle MePA pilot. If you are a payer and would like to enroll in the Mettle MePA pilot, or receive information about Mettle’s DRLS or PTIE solutions, please contact Mettle’s Director of Innovation, Melanie Combs-Dyer, at Melanie.Combs-Dyer@mettles.com.