Payers Extend Prior Authorization Windows During COVID-19

By Ellen Terry

Originally published on Texas Medical Association’s website.

Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency.

Below is an overview of some payers’ COVID-19 prior authorization policies:

Blue Cross and Blue Shield of Texas is temporarily extending approvals on services with existing prior authorizations until Dec. 31. This applies to services originally approved or scheduled between Jan. 1 and June 30. It applies to most nonemergent elective surgeries, procedures, therapies, and home visits for all group, fully insured, retail, self-funded, and Medicare Advantage members.. 

Aetna is approving prior authorization requests for commercial members for nine months instead of the standard six months. Physicians who already have received an approval for six months and plan to go over that time need to call Aetna to extend it for an additional three months. Aetna also will review precertification requests for elective procedures because the approvals are effective for a predetermined length of time.

Cigna: For prior authorization requests received March 25 until at least May 31, Cigna is temporarily increasing the authorization window for all elective outpatient services from three months to six months. This applies to all prior authorization requests received for all Cigna lines of business. Elective outpatient prior authorization decisions made between Jan. 1 and March 24 will be assessed when the claim is received and will be payable as long as it is within six months of the original authorization. 

Humana is extending previously approved authorizations to a 90-day approval timeframe, except for home health authorizations, which are being extended for 60 days.

UnitedHealthcare has instituted a 90-day extension of open and approved prior authorizations, including those for many physician-administered drugs, with an original end date or date of service between March 24 and May 31 for services at any setting. This applies to all individual and group health plans, and Medicaid and Medicare Advantage plans, and to in-network and out-of-network existing prior authorizations. Approvals issued on or after April 10 will not be subject to extension. If a prior authorization approves the number of visits or services, the physician must obtain a new prior authorization for additional units, visits, or services beyond what was approved in the original authorization.