Prior authorization helps health plans ensure certain recommended treatments and services are safe, evidence-based and high-value. Prior authorization has become cumbersome and inefficient in part due to outdated healthcare industry technology, including fax machines.
Blue Shield of California is teaming up with Salesforce to make prior authorization quick and easy while enabling more coordinated, personalized support for members.
Modifications or denials will always be made by a medical director or licensed clinician.
Our high-tech, high-touch system will:
Take a tour of our vision for what prior authorization should be.
The new platform solution will work alongside Care Connect — Blue Shield's award-winning care management system — to enable more personalized, coordinated care. In the future, a prior authorization request will automatically alert the health plan's team of nurses, social workers and behavioral health specialists that a member may need new or increased health support.
Health Reimagined — A bold vision to transform health care
Health Reimagined is Blue Shield's vision to transform the healthcare industry into one that works for members and providers. This means making prescriptions and treatments affordable, enabling care teams and members to make decisions based on data and preference, rewarding high-quality care, and creating a digital experience that has members' health information all in one place to prioritize their care and wellness — bringing the healthcare system into the modern age.
This is just the beginning