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Compliance 101: Prior Authorization (PARRD API)


Compliance 101: Prior Authorization (PARRD API)

March 9, 2023 | 2-minute read

Prior Authorization

About Prior Authorization (PAARD API)

Brought on by regulatory authorities in an attempt to increase efficiency and interoperability in the healthcare ecosystem, the Prior Authorization (PARRD API) mandate is an initiative designed to improve both the prior authorization process and overall healthcare delivery. By mandating the adoption of standardized APIs for seamless communication between payers, patients, and providers, this initiative will first and foremost build transparency between healthcare stakeholders while simultaneously providing members with access to better, more personalized care.

This Prior Authorization initiative is not solely focused on improving the patient experience - complying with the PARRD API requirement brings significant value for health plans as well. Due to the enhanced interoperability between health plans and providers that comes with this initiative, payers and providers will no longer have to spend unnecessary time and resources going back and forth with each other chasing and searching for specific documentation to authorize treatment. Digitalizing the end-to-end prior authorization process will allow providers and health plans to not only more quickly approve patient care, but it will also build transparency and expedite communication between the health plan, the provider and ultimately the patient, which will improve the overall member experience and lead to better outcomes.

There are plenty of pain points throughout the member care journey that can be targeted for improvement, but the prior authorization process may be seen as one of the quicker wins that can help prevent many of the downstream challenges we see today. Through the digital transformation efforts of many strong-willed healthcare experts, we are gradually moving toward more digitalized, real-time care experiences. In having access to real-time, connected and shared member data, health plans and providers can more effectively collaborate to avoid gaps in care caused by prior authorization discrepancies.

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