On July 1, 2018, HEA 1143 was signed into law. It creates greater transparency and accountability in the prior authorization (PA) process. It includes several key provisions.

• Beginning Sept 1, a health plan must disclose any new requirement for PA to providers at least 45 days before the requirement becomes effective, including publishing the disclosure conspicuously on the health plan’s website.
• A health plan must respond to an urgent care PA request within 72 hours of receiving it and respond to a non-urgent request no more than seven days after receipt. If a request for PA is denied, the health plan must state the specific reason for the denial. This provision applies to any PA request delivered to a health plan after Dec. 31, 2019.
• If a health plan has granted a PA request for a service, it cannot deny payment on a claim for that service unless the claim or request contains fraudulent or materially incorrect information or the patient was not covered under the health plan on the date the service was provided. This applies to any request for PA delivered to a health plan after Dec. 31, 2019.