New Prior Auth Rule Aims for API Adoption, 7-Day Turn by 2026

Prior authorization, a longtime bane of providers, is on track to become less burdensome thanks to a new Centers for Medicare & Medicaid Services (CMS) proposed rule. The good news is the rule includes Medicare Advantage, which was left out of a previous version. But results, already delayed once, may still come slowly.

On December 6th, CMS announced a proposed rule, “Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations,” which replaces the previous CMS rule from 2020. Some key aspects of the rule include: increased transparency into prior authorization decisions; quicker turnaround times for said decisions; and automating certain processes that remain heavily manual to this day.

Cohere Health’s Alina M. Czekai, Vice President of Strategic Partnerships & former Senior Advisor to CMS Administrator Seema Verma, who worked on the original rule, sat down with Roy Edroso, Editor, Part B News, to discuss how this new initiative would improve transparency within the prior authorization process, reduce physician burden, and result in faster access to patient care.

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