MO SB897

Health carriers cannot require prior authorization from providers who have a 90% or higher approval rate for a specific service or for all services during the most recent 6-month evaluation period

Carriers must notify providers within 25 days after each evaluation period of any prior authorization determinations, including supporting statistics and data

Carriers must maintain an online portal for providers to access all prior authorization decisions, request statuses, and notifications

Payment cannot be denied or reduced for services with prior authorization unless the provider knowingly misrepresented the service with intent to deceive or failed to substantially perform the service

Applies to health carriers and Medicaid managed care organizations, but excludes fee-for-service MO HealthNet and providers who have not participated in a health plan for at least one full evaluation period