Ama Policy

Eliminating Precertification H-320.950

U.R. Criteria

Our AMA will:

(1) advocate that all utilization review efforts focus on statistical outliers, rather than routine blanket review of whole populations of physicians or all instances of particular services;

(2) advocate that managed care plans restrict their preauthorization requests to physicians whose claims have shown to be statistical outliers; and

(3) encourage CMS to adopt regulations prohibiting Medicare secondary insurance carriers from utilizing independent precertification criteria.

Policy Timeline

Res. 705, A-99 Reaffirmation A-01 Reaffirmation A-02 Reaffirmation I-04 Reaffirmation A-05 Reaffirmation A-06 Reaffirmation A-08 Reaffirmed in lieu of Res. 839, I-08 Reaffirmation I-10 Reaffirmed: Sub. Res. 215, I-14 Reaffirmation: A-17 Reaffirmation: I-17