Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) proposed a new rule to streamline prior authorizations and improve electronic healthcare data transfers between doctors, patients and insurance companies. The rule will require payers involved in certain government programs to build apps for the purpose of this exchange and prior...CMS Rules
The new model now requires providers to get prior authorization (PA) before scheduling a non-emergent ambulance transport for a patient and pays ambulance services for taking patients to non-hospital facilities.
A ride in an ambulance can cost between hundreds and thousands of dollars depending on locations, services and the...National News
During a speech at the American Medical Association's National Advocacy Conference this month, CMS Administrator Seema Verma characterized prior authorization (PA) as "indefensible" and a "longstanding problem" in healthcare. Recent analysis shows alarming inefficiencies.
This year, our efforts around innovation and reducing...Arizona News
According to the American Medical Association the words patients and physicians use to describe the current prior authorization process: Time-consuming, tedious and horrendous.
During its annual meeting of delegates, The American Medical Association announced it wants government officials to carefully consider evidence that prior...
Attention focused after a former Aetna medical director admitted he never reviewed patient medical records when deciding whether to authorize treatment.
California Insurance Commissioner Dave Jones confirmed he is launching an investigation into Aetna's processes in denying claims and requests for prior authorization for care, as...