Prior Authorization Management
Expert articles and analysis related to prior authorization management.
AI Summary — Last 30 Days
In the past month, CMS has imposed significant sanctions on Elevance Health’s Medicare Advantage plans, freezing enrollment amid allegations of noncompliance with risk adjustment and data submission requirements. This move reflects intensified regulatory scrutiny as part of CMS's broader agenda, including the new WISeR (Wasteful and Inappropriate Service Reduction) model, which employs technology-enabled prior authorization to combat fraud and optimize service delivery. These developments illustrate a critical shift towards greater accountability and efficiency in Medicare Advantage programs, directly impacting ACOs and value-based care strategies as stakeholders adapt to evolving compliance expectations and potential financial repercussions. For further details, see the coverage on healthcaredive.com and healthcarefinancenews.com.
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Question - Horizon BCBS denying 99402 AAPC
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New approaches to prior authorization are crucial to improve a process that remains essential to supporting healthcare quality, according to a subject matter expert. “Prior auth exists because there’s...
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Last summer, the Trump administration announced a voluntary pledge by health insurers to reform prior authorization, which often requires patients or their doctors to seek preapproval from insurers be...
Georgia lawmakers move to limit AI’s role in health insurance denials
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5 new things to know about the No Surprises Act: GAO report
The No Surprises Act, which went into effect in 2022, prohibits out-of-network healthcare providers from sending “surprise bills” to patients with private health insurance and creates an independent r...
Smarter Prior Authorization: Improving Outcomes Without Adding Burden
Smarter Prior Authorization: Improving Outcomes Without Adding Burden NCQA
Elevance expands policy penalizing out-of-network referrals
Elevance expands policy penalizing out-of-network referrals Modern Healthcare
Elevance to expand 10% out-of-network penalty policy into California
Elevance to expand 10% out-of-network penalty policy into California Becker's Hospital Review
DMEPOS Written Order and Prescription Requirements: Reduce Documentation Burdens
DMEPOS Written Order and Prescription Requirements: Reduce Documentation Burdens AMGA.org