Becker's Healthcare December 7, 2022
CMS issued a proposed rule that it says will streamline the prior authorization process and estimates the efficiencies introduced in the proposal would save hospitals and physician practices more than $15 billion over a 10-year period.
The proposed requirements would generally apply to Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program agencies, Medicaid managed care plans, CHIP managed care entities, and qualified health plan insurers on the federally facilitated exchanges, according to a Dec. 6 CMS news release.
The proposed rule would:
- Require the implementation of a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface to support electronic prior authorization.
- Require certain payers to include a specific reason when denying requests,...
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