April 1, 2024 – (Medical Economics) –

Prior authorization (PA) has long been a care and coverage bottleneck for all involved—patients, members, providers, and payers. What’s been needed is structure to connect all stakeholders and systemize the process. In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized requirements to streamline the prior authorization process; this proposed requirement will be enacted in January 2026. This new regulation aims to shorten the timeline for the prior authorization process to immediate or as little as 72 hours for individuals who get their health insurance through Medicare Advantage, Medicaid, or a Qualified Health Plan on the exchanges by automating prior authorizations at the point of care.

Article originally published by Medical Economics