Ama Policy

Utilization Review, Medical Necessity Determination, Prior Authorization Decisions D-320.977

U.R. Criteria

1. Our AMA will advocate: (a) for implementation of a federal version of a prior authorization “gold card” law, which aims to curb onerous prior authorization practices by many state-regulated health insurers and health maintenance organizations; and (b) that health plans should offer physicians at least one physician-driven, clinically-based alternative to prior authorization, including a “gold-card” or “preferred provider program.”

Policy Timeline

Res. 727, A-22; CEJA Rep. 01, A-23