The term “physician” is used on this page primarily for convenience. Other categories of health professionals may also be affected by the new rule. In some case, it may be appropriate to delegate certain actions to non-clinical staff.

TPA = Third-party administrator

Online prior authorization

Starting Nov. 1, 2019, insurance carriers and TPAs are required to provide a secure, online process for participating physicians to complete a prior authorization request and upload documentation when required.

While this online option must be offered in addition to other current methods, such as fax machines and 800 numbers, the goal of this provision is to move the industry away from reliance on outdated, inefficient technology. The OIC believes that online tools can significantly improve the prior authorization process.

This provision does not apply to integrated delivery systems.