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AMA approves Delaware doctors' plan to automate prior authorization

[Public domain], via Wikimedia Commons

The American Medical Association (AMA) is giving Delaware doctors the green light to automate the prior authorization process.

Prior authorization is required by insurance companies for doctors to perform many medical procedures. It is meant to protect patients from fraud and abuse, but requires paperwork and can take a couple days to process.

A Medical Society of Delaware resolution was recently approved by the AMA to automate that process in the First State so patients don’t have to wait as long for those procedures.

Medical Society President Dr. Andrew Dahlke says automating prior authorization will save time and money.

“If the patient has to wait two days to get a CT scan, they may just go to the ER and get it because they can’t say no in the ER, and the ER cost is much higher than the outpatient cost,” said Dahlke. “So the whole idea is to deliver the care in a timely manner to the lowest cost to the patient.”

Dahlke also points out the average doctor spends 16 hours a week on prior authorization paperwork. He points to a national shortage of primary care physicians and says he hopes the resolution will eventually be adopted on a national level.

“If we can get it to work in Delaware and in a couple other states, then maybe the national organizations will see the benefit of it and will take it up as a bipartisan bill,” he said.

Dahlke says block chain technology will likely be used to automate prior authorization as a secure platform for communication between Delaware doctors and insurance companies.

He says the Medical Society is working on a bill here to eliminate the need for prior authorization from an insurance company entirely when certain procedures have already been approved through Medicaid. It is unlikely to see a vote in the General Assembly until next year.

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