The final blog in our series, focusing on Execution & Iteration, brings our compliance journey to its most dynamic phase. Read the first and second blogs in the series to catch up...
Beyond Compliance: Transforming Insights into Impact – The Journey from Analysis to Action
In the first blog of this series, we broached the complexities of the "Assess and Analyze" phase, emphasizing the importance of a thorough understanding of the regulatory...
Beyond Compliance: The Strategic Roadmap – Starting with Assessment and Analysis
The CMS rule on advancing interoperability and improving prior authorization (CMS-0057-F) sets a foundation for future policymaking. As payers embark on this compliance journey,...
Adapting to State Reforms in Prior Authorization Processes: Opportunities and Challenges for Healthcare Entities
As state legislatures intensify efforts to reform prior authorization processes, these changes may reflect broader regulatory trends such as those outlined by CMS in rules like...
CMS Rule Drives New Era of API-Enabled Data Sharing & Prior Authorization Reform
On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a long-awaited final rule aimed at advancing interoperability and enhancing prior authorization...
Washington State Takes a Leap to Require FHIR APIs and Reshape Prior Authorization
Washington State has taken a pioneering leap in reshaping the landscape of prior authorization, racing ahead of federal guidelines by mandating the use of FHIR (Fast Healthcare...
Could Gold-Carding be a Transformative Factor for Prior Authorization?
The concept of "Gold-carding” is an emerging policy trend that has the potential to significantly transform prior authorization (and claims) procedures. As an evolving concept, it...
Highlights of the Advancing Interoperability and Improving Prior Authorization Processes Notice of Proposed Rulemaking (NPRM)
Reading and analyzing proposed rules is a necessary, albeit time consuming task. In order to help healthcare stakeholders, we’ve compiled some highlights of what is included in...
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