Prior Authorization Processes
Expert articles and analysis related to prior authorization processes.
AI Summary — Last 30 Days
Over the past month, CMS has intensified its oversight of Medicare Advantage (MA) plans, exemplified by its decision to freeze enrollment in Elevance Health’s MA and Part D plans due to alleged noncompliance with risk adjustment and data submission requirements. This action signifies a structural shift towards heightened accountability and scrutiny within the MA landscape, reinforcing the importance of accurate data reporting and compliance in value-based care frameworks. Additionally, CMS's launch of the WISeR Model aims to address fraud, waste, and abuse by utilizing technology-enabled prior authorization processes, targeting services believed to be vulnerable—a move that could reshape how care delivery is managed under value-based arrangements and influence ACO strategies moving forward. For further details, see the recent reports on Elevate's enrollment freeze and the WISeR program.
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