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Blue Cross Blue Shield of MA removes prior authorization requirements for home care services

We here at MBM commend Blue Cross Blue Shield of Massachusetts (Blue Cross) for its recent announcement to remove prior authorization requirements for home care services for commercial members. This change, effective January 1, 2024, will have a positive impact on healthcare providers and patients alike. By eliminating prior authorization for home care services, Blue Cross is streamlining the discharge process and reducing administrative burden on clinicians.


This change will enable hospitals to expedite discharges, alleviating overcrowding and capacity issues. Additionally, it will reduce delays for members who are ready to transition from hospital to home care. "We applaud Blue Cross Blue Shield of Massachusetts for recognizing the obstacles that prior authorization requirements can present in accessing home care services," said Curt Anderson, CEO of Medical Billing Management. "Removing these requirements will not only benefit patients but also improve operational efficiency for healthcare providers."


Prior authorization is a process through which healthcare providers seek advanced approval from a health plan to ensure that a service or treatment is covered and necessary.


While prior authorization serves as an important tool for health plans to ensure cost-effectiveness and appropriateness of care, it can sometimes delay the delivery of necessary services. Blue Cross has been proactive in removing prior authorization requirements for various conditions and procedures. This step aligns with their commitment to improve health outcomes and lower costs for their members. It is worth noting that 98% of Blue Cross claims already do not require prior authorization. We believe that streamlining the prior authorization process is crucial for reducing administrative burden and improving patient care. The company supports Blue Cross' efforts to explore automation solutions to make the prior authorization process more efficient for healthcare providers and members.


As a medical billing company, Medical Billing Management understands the importance of efficient and streamlined billing processes. We are committed to working collaboratively with insurance companies like Blue Cross to ensure a seamless medical billing experience for healthcare providers and their patients. MBM is dedicated to improving the financial performance and operational efficiency of healthcare providers.


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