Utilization Management
Expert articles and analysis related to utilization management.
AI Summary — Last 7 Days
The Trump administration’s WISeR Medicare AI prior authorization test became the central utilization-management flashpoint this week, as Senate Republicans blocked Democrats’ effort to terminate the pilot, preserving CMS’ push to use AI-enabled review in Traditional Medicare despite concerns about delayed care and denial risk for seniors (Healthcare Dive). At the same time, momentum continued for Medicare Advantage prior authorization reform, with healthcare groups backing a unanimously approved MA prior-auth bill—signaling a widening policy split: CMS is testing tighter automated utilization controls in fee-for-service Medicare while Congress pressures MA plans to make UM faster, more transparent, and less burdensome for providers (MedCity News
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