Alaska Statutes Title 21. Insurance § 21.07.150. Prior authorization application programming interface

A health care insurer shall maintain a prior authorization application programming interface that automates the process for health care providers to determine whether a prior authorization is required for medical care, identify prior authorization information and documentation requirements, and facilitate the exchange of prior authorization requests and determinations from its electronic health records or practice management system.  The application programming interface must be consistent with the technical standards and implementation dates established in the Centers for Medicare and Medicaid Services rules on interoperability and patient access.  The application programming interface must support the exchange of prior authorization requests and determinations for medical care and prescription drugs, including information on covered alternative prescription drugs.  The application programming interface must indicate that a prior authorization denial, an authorization of medical care less intensive than the medical care included in the original request, or an authorization of a prescription drug other than the one included in the original prior authorization request is an adverse benefit determination and is subject to the health care insurer's grievance and appeal process under AS 21.07.005.