Insurance & Benefit Design
Expert articles and analysis related to insurance & benefit design.
AI Summary — Last 7 Days
CMS finalized the CY 2027 Medicare Advantage and Part D Rule, introducing significant changes in insurance and benefit design aimed at tightening oversight for plan sponsors and enhancing beneficiary protections, with a direct focus on improved transparency and streamlined appeals processes—key levers for advancing value-based care in Medicare Advantage and Part D programs (Crowell & Moring). Meanwhile, CMS's proposed rule requiring payers to support electronic prior authorization for
Related Articles
The LI Daily: Prior Authorization: I Killed It Once. They Brought It Back. Now the Data Shows Why.
Prior Authorization: I Killed It Once. They Brought It Back. Now the Data Shows Why. A former health plan CMO followed the money — and the numbers are worse than the industry wants you to know. Archel...
More insurance claims denials are being overturned upon appeal, study finds
Study authors, who reviewed data from New York, said rising rates of overturned claims suggest that insurers’ claims review processes might not be working as intended, and policymakers should consider...
The Operational Drag of Prior Authorizations and the Moral Hazard Impact on Patients
Prior Authorization Is Source of Greatest Patient Burdens in the Health System, Poll Finds
Payers need to speed up prior authorization for drugs under proposed rule
Health insurers face a prior authorization prescription drug mandate similar to the rule imposed on claims, under a proposal released Friday by the Centers for Medicare & Medicaid Services.CMS is prop...
CMS proposes new deadlines for prior authorizations for drugs
Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to addres...
How CVS Caremark is using innovative technology to simplify the prior authorization process
How CVS Caremark is using innovative technology to simplify the prior authorization process Fierce Healthcare
2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule | CMS
From newsletter: Join HTN live on The Grand Roundup today, 1p ET / 10a PT Join HTN live on The Grand Roundup today, 1p ET / 10a PT Gabe Drapos of Pearl Health on inferred risk, Conor Green from Truehe...
Treatment Delays, Denials More Common in Prescriptions Initially Rejected
Listen: With Little Federal Regulation, States Are Left To Shape the Rules on AI in Health Care
As artificial intelligence embeds itself into health care, some physicians and patient advocates worry it could be used by insurance companies to refuse payment for care. Maryland passed one law banni...