Proactive Interventions for the Prior Authorization Process-How to Prepare for the Prior Authorization Blizzard

Video Transcription

Video Summary

The webinar, part of ACCC’s six-part series on prior authorization, focused on how cancer clinics can prepare for the “prior authorization blizzard” of January insurance changes. Speakers Sarah Hudson-Dessau and Jordan Karitsky described prior authorization as a major administrative burden that often delays care, creates confusion, and increases appeals workload.<br /><br />Sarah shared findings from ACCC focus groups with physicians, nurses, navigators, and financial counselors. Key themes included treatment delays, lack of payer transparency, manual processes, long hold times, confusing peer-to-peer reviews, and the need to better educate patients. Recommendations included stronger advocacy for reform, clearer payer communication, automation, electronic workflows, and standardization of terminology and processes.<br /><br />Jordan provided practical strategies from clinic operations: set expectations with providers about authorization timelines, track annual insurance changes, collect updated insurance cards early, and build EMR workflows to monitor authorization status. She emphasized using payer portals and online tools, keeping documentation current, and creating internal processes to catch policy changes before they cause denials.<br /><br />The Q&A addressed common issues like quantity limits, radiation denials, biosimilar substitutions, site-of-care restrictions, and reference numbers for appeals. Overall, the session stressed collaboration, documentation, automation, and advocacy to reduce delays and improve patient access to care.

Asset Caption

In the first webinar, we heard from Sarah Hudson-DiSalle, PharmD, Rph, Pharmacy Manager, from The James Cancer Hospital, and Jordan Karwedsky, Financial Counselor from Green Bay Oncology. In this webinar, we discussed ACCC Prior Authorization Focus Group findings, payer recommendations, and how to best prepare for the prior authorization "blizzard" for next year.

Keywords

prior authorization

cancer clinics

insurance changes

administrative burden

treatment delays

payer transparency

EMR workflows

appeals process

patient access to care