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State lawmakers are trying to find gentle ways to help health insurers and doctors get along better.
The executive committee of the National Council of Insurance Legislators has adopted a model act based on prior authorization rules adopted in Mississippi.
The model would let health insurers and health plans continue to talk to doctors in advance before patients seek coverage for certain types of care, such as MRI scans and back surgery.
But, under the terms of the model law, a plan would have to:
◆ Post a list of the services subject to prior authorization reviews on the web.
◆ Post prior authorization prior approval and denial statistics on the web.
◆ Complete some expedited prior authorization reviews within 24 hours.
◆ Make sure qualified physicians review appeals.
◆ Send prior authorization program tracking data to state regulators.
What it means: Many states could soon consider prior authorization bills based on part or all of the NCOIL model act.
NCOIL: The U.S. federal government leaves efforts to regulate the business of insurance to the states.
NCOIL is a Belmar, New Jersey-based group for the representatives, senators, assemblymembers and other legislators who serve in state-level legislatures and have an interest in insurance.
NCOIL has no ability to change insurance laws or regulations directly, but states often start with its models when drafting their own bills and regulations.
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