Aligns prior authorization application programming interfaces with federal guidelines.

The bill mandates that managed care organizations and carriers implement application programming interfaces (APIs) for prior authorization that comply with federal guidelines. It sets specific timeframes for decision-making on standard and expedited prior authorization requests, both electronic and non-electronic. The APIs must support automated processes, use nonproprietary open workflows, and be based on evidence-based clinical review criteria that consider equity for underserved populations.

Aligns prior authorization application programming interfaces with federal guidelines.

The bill mandates that managed care organizations and carriers implement application programming interfaces (APIs) for prior authorization that comply with federal guidelines. It sets specific timeframes for decision-making on standard and expedited prior authorization requests, both electronic and non-electronic. The APIs must support automated processes, use nonproprietary open workflows, and be based on evidence-based clinical review criteria that consider equity for underserved populations.