Compliance to Prior Authorization Mandates Is a Scope Challenge for Payers

This IDC study looks at establishing an overall vision and road map for prior authorization (PA) in payers and where the enterprise approach is going with its PA journey. Modularly implementing sections of the needed technology architecture seems the most appropriate path. "While less attractive to implement, pulling back from the 'check the box' or 'avoid the fine' mindset seems prudent. Payers should move in a modular fashion toward an enterprise operating model that optimizes consistency, flexibility, and cost while addressing compliance with mandates," says Jeff Rivkin, research director for IDC Health Insights.