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An insurance representative reviewing health benefits options with a client.
An insurance representative reviewing health benefits options with a client.

The First Prior Authorization Resource for Insurers and Pharmacy Benefit Managers

Do you represent a private payer, such as an insurer or pharmacy benefit manager (PBM)? If so, you may be familiar with your organization’s role in the prior authorization process, a process that can be unique to each insurer, including claims criteria for approval. Those stakeholders who aren’t familiar with the process, like patients, and even advisors, can benefit from some extra help.

The Simplify Prior Authorization website was developed to provide information for all prior authorization stakeholders, even insurers and PBMs. The I am an Insurer or PBM tab of the site was specifically developed with payers in mind. It provides insights into the experiences of other stakeholders and suggestions for some simple common-sense improvements in the process.

The I am an Insurer or PBM tab includes four sections:

  1. Why The Interest in Prior Authorization?
  2. Prior Authorization Stakeholders and Prior Authorization
  3. When a Claim Has Been Denied
  4. Improving Prior Authorization

There is more! You will see additional sources under the Resources tab of this site. You may find some useful links for your use, or sometimes you may decide to direct plan members to this tab or the Patient or Patient Group tab when there are questions about the resources and information that is available, or about the process.

For more information on prior authorization, other aspects of the Simplify Prior Authorization initiative, or how to get involved or support the website, contact Denise Balch at info@simplifypriorauth.ca.

What’s next? We are working on recommended best practices for prior authorization. Stay tuned!

Want to stay connected?

Our LinkedIn Page provides useful resources and information related to Prior Authorization with resources available for patients, benefits and healthcare stakeholders, follow our LinkedIn Page to stay up to date.

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