Do you pay or adjudicate prior/special authorization claims? Do you want to be recognized for your prior authorization (PA) processes, or do you plan to make changes to improve them?
If yes, then your organization should consider membership with a view to applying for accreditation with the new Prior Authorization Framework and Accreditation (PAFA) Program.
Established in Fall 2024, with input from a wide group of PA stakeholders, PAFA is a Canadian non-profit dedicated to recognizing those organizations, both public and private, who are committed to improving the PA process for specialty and high-volume medications. PAFA offers membership to payers, associate membership to non-payers, and accreditation to public or private payer members who implement efficiencies in their PA practices.
Understanding PAFA Accreditation
The first step to payer accreditation is joining PAFA as a member. To become a member public and private payers must commit to PAFA’s four Guiding Principles:
- Communication: Ensuring PA information is patient-centric, using plain language that is easy to understand and meets accessibility standards.
- Transparency and Fairness: Building transparency into all non-proprietary aspects of PA to improve stakeholder understanding and ensure timely information on claim status.
- Consistency: Developing evidence-based, informed, and consistent guidelines, practices, and decision-making that promote equitable and reliable access to positive patient outcomes.
- Efficiency: Striving for continuous improvement by adopting new technologies, including electronic prior authorization (ePA), to enhance the patient and stakeholder experience.
Not a payer? Did you know that non-payers are also encouraged to join PAFA as an associate member to support improvements in prior authorization and to get involved.
Accreditation Levels
The PAFA Program offers three levels of accreditation for payer members:
- Administration Efficiencies (AE): Recognizes payers who have adopted efficient PA claims administration practices and processes that are outlined in the PAFA Program Guide.
- Electronic Prior Authorization (ePA): Acknowledges payers who have implemented electronic systems to streamline the PA process.
- Gold Certification: Awarded to payers who achieve both AE and ePA accreditations, demonstrating a comprehensive commitment to PA excellence.
Details of the requirements for accreditation are in Section 3 of the PAFA Program Guide, which is available for download from the PAFA website.
Accreditation recognizes a payer’s dedication to improving the prior authorization claims process by improving communication, reducing the administrative burden, reducing claim processing times, and ensuring that patients receive the timeliest access to prescribed medications.
Benefits of PAFA Accreditation
- Competitive Advantage: Accredited payers can differentiate themselves in the marketplace by showcasing their commitment to superior PA practices.
- Stakeholder Trust: Demonstrating adherence to established standards fosters trust among patients, healthcare providers, and other stakeholders.
- Operational Efficiency: Implementing the PAFA Framework can lead to streamlined processes, reducing costs and improving service to patients and other PA stakeholders.
How to Apply for Accreditation
Payers interested in pursuing PAFA accreditation should first become a PAFA member. Membership details, including benefits and application procedures, are outlined in Section 4 of the PAFA Program Guide. Membership forms can be completed online at www.priorauthframework.ca/payer-membership/.
Members can apply for any one or more accreditation levels by completing an accreditation application and providing the required supporting documentation. Applications will be available in Q2 2025 by contacting denisebalch@priorauthframework.ca.
Join the Movement Towards Better PA Practices
Public and private payers are encouraged to explore membership and accreditation. Those who become members can be active participants in the operations and the future of the PAFA Program. Those who become accredited not only commit to improving PA processes but are also supporting a broader effort to improve healthcare delivery to patients in Canada.
Embrace the opportunity to lead in PA innovation and make a tangible difference in patient care. For more information on accreditation and membership, explore the PAFA website or contact Denise Balch at denisebalch@priorauthframework.ca or call 905-220-4260.
