Anthem Blue Cross and Anthem Blue Cross and Blue Shield are deeply committed to ensuring their members receive safe, high-quality, evidence-based, clinically appropriate care. Prior authorization is a key part of this commitment.
Prior authorization helps ensure that patients receive care and medications that are based on scientific evidence, aligned with medical policy, and that they’re not receiving or paying for services or treatments they don’t need.
Along with the Blue Cross Blue Shield Association and AHIP, our partner Anthem is announcing commitments regarding prior authorization processes to connect patients to the right care faster and reduce administrative burdens on care providers.
Accelerating Decisions
Anthem is leveraging advanced technology, including artificial intelligence (AI), to speed up prior authorization approvals, which in turn reduces delays in care. This also reduces administrative burdens on providers, allowing them more time to care for their patients.
Importantly, Anthem does not and will not use AI to make prior authorization denial decisions. Denial decisions are only made by licensed clinicians.
Simplifying Processes
To make care providers’ experience with Anthem easier, more efficient and effective, Anthem is simplifying, streamlining, and automating time-consuming processes, making it quicker and more convenient for care providers to interact with them.
As an example, our partner has gold card programs where high performing medical groups in value-based care arrangements have hundreds of outpatient PA requirements waived or bypassed. Anthem is now expanding these efforts.
Commitment to Responsible Use of AI
Anthem’s use of AI with prior authorization focuses on speeding up approvals and reducing administrative burdens, and they follow strict ethical guidelines and comply with all state and federal laws to ensure privacy and security.
Anthem is committed to responsible, ethical technology use to enhance healthcare outcomes while maintaining transparency and patient trust.
Our carrier partner looks forward to sharing more updates on their work to build a more transparent, responsive health system that better serves the needs of patients and care providers alike.