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Wyoming Medicaid Starts Blue Ribbon Program to Reduce Physician Burden
Prior Authorization continues to be a hot topic for physicians and PAs. I know all too well the burden of prior authorization requests for indicated medications, studies and surgery for my patients. Statistics put out by the American Medical Association are sobering and affirming. The average physician practice completes 45 prior authorizations per physician. 94% of physicians report care delays while waiting for insurers to authorize necessary care and 33% report that prior authorization has led to a serious adverse event.
Taking this into account Wyoming Medicaid, with our contractor Telligen, has initiated the Blue Ribbon program, similar to the “gold card” programs through commercial insurers. To this end, providers who meet standards for frequency, performance and approval rates will receive exemptions from prior authorization requirements for procedure codes.
Providers who meet criteria will receive auto-approval of requests with minimal demographic and service information entered into the Qualitrac system. Blue Ribbon providers will also have the opportunity to receive reporting that shows their algorithm-based outcomes. There will be ongoing quality reviews to maintain the designation.
We sincerely hope this is a step to reduce the administrative burden on providers and their staff, allowing more time to provide care to patients or for pursuits outside of the office.
Best,
Paul
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