In the spring of 2017, in response to WEDI member input and WEDI leadership participation at a number of industry forum sessions, including an event sponsored by HIMSS, the WEDI Board of Directors chartered the Prior Authorization Council (PAC) to create a forum for communication between primary stakeholders in the Prior Authorization process.
The organizations holding membership in the WEDI Prior Authorization Council are as follows:
• American Medical Association
• America's Health Insurance Plans
• Blue Cross Blue Shield Association
• Council for Affordable Quality Healthcare
• The Cooperative Exchange
• Healthcare Administrative Technology Association
• Health Information Management Systems Society
• HL7
• Medical Group Management Association
• National Council for Prescription Drug Programs
• WEDI Prior Authorization Sub Work Group
• X12
WEDI has statutory standing to advise the Secretary of the Department of Health and Human Services (HHS) on matters related to the use of electronic transactions in health care. As such, the intent of the PAC was to survey the work being done by key industry stakeholders and pull together a body of information regarding the state of the prior authorization process as currently implemented between US payers and providers. That body of information will inform any testimony or advice that WEDI provides to the Secretary.
The observations, findings and recommendations that follow represent the output of the Council’s three phases of activity.