OSP News

Priority Health and New Prior Authorization Legislation

Posted: 03/30/2023

In April 2022, Governor Whitmer signed the prior authorization reform bill, Public Act 60 (PA 60), into law. Priority Health is excited that this legislation supports streamlining how they work with physicians, making it easier for their members – your patients – to get the care they need when they need it. 

Meeting PA 60 requirements 

As a plan accredited by the National Committee for Quality Assurance (NCQA) and adherent to NCQA’s Utilization Management standards, they already meet a large portion of the PA 60 requirements. They’re on track to meet all other legislative guidelines on or before June 1. Here are a few highlights Priority Health would like to call out for you: 

Reduced prior authorization turnaround times 

Starting June 1, Priority Health will reduce turnaround times for non-urgent, standard prior authorization requests from 15 days to 9 days for commercial, individual / ACA and governmental self-funded plans. Urgent requests will maintain the current 72-hour turnaround time. 

Authorization requirement lookup tool 

By June 1, providers will see a new tool available in prism. This tool will allow providers to look up a service’s prior authorization requirements and clinical criteria based on a member’s plan type – before submitting a request.  Priority Health will also enhance their authorizations quick reference list to include all services requiring prior authorization. 

Member access to clinical criteria 

On June 1, members will have access online to a comprehensive list of services which require prior authorization and their associated clinical criteria, for the first time. They may reach out to their providers for help understanding the criteria.  Priority Health is on track to meet all other legislative guidelines on or before June 1. For a detailed breakdown of PA 60 requirements and health plan status, click here to read the recent news on the Priority Health website. 

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