Prior Authorization Processes
Expert articles and analysis related to prior authorization processes.
AI Summary — Last 7 Days
In the last week, the Centers for Medicare & Medicaid Services (CMS) announced its acceptance of comments on data collection requirements for Medicare Advantage plans and Part D sponsors, indicating a shift towards increased oversight and accountability in these programs. Additionally, concerns around prior authorization processes and fraud detection continue to impact provider economics, with recent tension highlighted in the context of outpatient surgery centers facing escalating payer tactics that threaten financial viability. Initiatives led by CMS, including efforts to enhance medical necessity documentation and manage care delivery transformation, are increasingly relevant as they seek to balance cost management with quality care delivery for populations in value-based care frameworks, particularly in light of ongoing reforms emphasized by the current administration under HHS Secretary Robert F. Kennedy Jr.
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The first piece of news for today is that the Centers for Medicare & Medicaid Services (CMS) has finally released a new version of the Advance Beneficiary Notice of Non-Coverage, the ABN. As I reporte...
ZeOmega Recognized in the 2026 Gartner(R) Market Guide for Intelligent Prior Authorization, U.S. Healthcare Organizations
ZeOmega Recognized in the 2026 Gartner(R) Market Guide for Intelligent Prior Authorization, U.S. Healthcare Organizations  Tri-City Herald
Payers, providers face challenges in meeting Interoperability and Prior Authorization Final Rule
The payer tactics quietly breaking ASC economics
ASC leaders far and wide agree payers have the upper hand in reimbursement negotiations, but each has their own take on which particular set of tactics is doing the worst damage to the economics of ou...
Payers, providers face challenges in meeting Interoperability and Prior Authorization Final Rule
LAS VEGAS – Ten percent of payers and 33% of providers have not yet started work on Prior Authorization Application Program Interface requirements, according to survey results released by the Workgrou...