Continued Relaxation of Prior Authorization Procedures for COVID-19

On June 25, 2020, the Division of Insurance issued Bulletin 2020-21, requiring insurance carriers to continue to provide flexibility because of the COVID-19 public health crisis. Specifically, the bulletin requires carriers to continue to:

  • Forego prior authorization reviews or concurrent reviews for any scheduled surgeries and behavioral health or nonbehavioral health admissions at acute care and mental health hospitals for a period lasting through September 30
  • Devote carrier resources to assist hospitals with discharge planning
  • Provide hospitals additional time to respond to carrier request for claims review information or to process internal and external appeals and document claims
  • Delay audits of hospital payments
  • Process all clean claims according to prompt payment standards
  • Explore ways to streamline coding and billing policies to reduce the administrative complexity of coding for claims
  • Develop a process that expedites health plan credentialing

Additionally, the guidance indicates that it would not be appropriate for carriers to require prior authorization of COVID-19 treatment or to conduct retrospective reviews to deny emergency or inpatient hospital services for COVID-19 treatment.

This requirement falls on insurers, but employers should also familiarize themselves with this guidance in case any employees ask about it.

Bulletin 2020-21 »