Healthsperien Summary Available: Prior Authorization and Interoperability Final Rule

Healthsperien released its comprehensive summary of the Centers for Medicare and Medicaid Services’ (CMS) Advancing Interoperability and Improving Prior Authorization Processes final rule, which applies to Medicare Advantage (MA) organizations, Medicaid and CHIP fee-for-service (FFS) programs, Medicaid managed care plans, Childrens Health Insurance Program (CHIP) managed care entities, and qualified health plans (QHPs) on federally facilitated exchanges (FFEs). This final CMS rule overall aims to improve patient, physician, and payer access to interoperable patient data and reduce the burden of prior authorization processes. Specifically, it includes provisions to improve prior authorization processes through policies and technology to enhance communication between patients, physicians, and payers.

For a detailed summary of the proposed rule, read Healthsperien’s comprehensive section-by-section analysis.

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