Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG).. The OIG review ...

CMS is not proposing payers must use implementation guides for the installation of APIs, which was a requirement in the 2020 rule. The agency conceded that while the guides will “play a critical ...

IHA and hospital representatives spoke to members of the Medicaid Legislative Working Group on April 11. They are advocating for House Bill 4977 and Senate Bill 3372, which permit emergency ...

One proposed rule regarding electronic prior authorization information exchange (CMS-0057-P) requires federally regulated health plans to offer Health Level 7 (HL7) FHIR-based APIs, while another ...

Medicaid managed care organizations (MCOs) denied one out of every eight prior authorization requests in 2019 and lack oversight of denials in most states, according to a report by OIG.

Health insurance companies and states will have to resolve prior authorization requests more quickly under a final rule the Centers for Medicare and Medicaid Services published Wednesday. Insurers ...

The Centers for Medicare and Medicaid Services finalized the CMS Interoperability and Prior Authorization Rule on Wednesday. CMS said the rule will improve the prior authorization process and save ...

Expert Opinion CMS's Proposed Rule Improves Prior Authorization Processes A discussion of the Centers for Medicare & Medicaid Services' recent focus on promoting patient care by removing ...