The challenge

Many health plans require prior authorization (PA) for coverage of certain services. The PA process can help save the health plan and member money and can sometimes help avoid invasive therapies by determining if services are medically appropriate. However, the PA process can also be quite frustrating for members. After providers submit PA requests, members often feel disconnected from the process while they wait for results. Many members call their plan for updates, increasing the plans' administrative costs, while others wait anxiously, feeling increasingly frustrated with their health plan.

The organization

BlueCross BlueShield of South Carolina (BCBSSC), headquartered in Columbia, SC., is one of the largest insurers in the state of South Carolina. It serves members in the commercial, individual, Medicare, and Medicaid lines of business.

The approach

BCBSSC responded to member feedback and invested in a new PA tracker in their mobile app and web portal which allows members to track the progress of their PA requests through various stages of the approval process. Their tool was modeled on popular pizza trackers to make an otherwise complex and unintuitive process easy for members to understand.

The result

BCBSSC’s prior-authorization tracker prototype was launched 10 months after ideation. Members can now track the status of their PA requests in the tracker that is updated every 15 minutes. There is a 26% click-through rate for emails and texts that BCBSSC sends with PA tracker updates.