Rule and workflow ledger
A chronological record of material rule, standards, company, product, operating, and research changes. Each entry preserves the source class, effective date, market consequence, and affected capability areas.
NCPDP SCRIPT 2023011 becomes the required e-prescribing version
The federally named SCRIPT 2023011 transition includes electronic prior-authorization transactions and becomes required January 1, 2028.
First Medicare Part C UM annual data submission becomes due
Medicare Advantage organizations were required to submit information on internal coverage criteria used by them or delegated entities for 2026 Part C prior authorizations.
Seven additional DMEPOS codes enter nationwide required prior authorization
CMS added five orthoses codes and two pneumatic compression device codes to the DMEPOS Required Prior Authorization List effective April 13, 2026.
CMS releases CMS-0062-P for drug prior authorization and interoperability
CMS proposed extending electronic prior-authorization, decision-time, transparency, API, and standards requirements to drug authorizations. The provisions remain proposed, not final.
Initial CMS-0057 prior-authorization metrics become due
Impacted payers were required to publicly post the initial set of prior-authorization metrics by March 31, 2026 under CMS-0057-F.
EviCore begins handling additional Cigna authorization categories
An official provider notice directs affected Cigna plan requests for specified DME, unlisted, experimental or unproven, cosmetic, and outpatient surgery categories to EviCore beginning March 7, 2026.
GuidingCare adds a multi-vendor Decision Intelligence Ecosystem
HealthEdge launched integrations with Anterior, Latitude Health, and Case Health AI for utilization-management decision support and automation.
HL7 publishes updated CRD, DTR, and PAS implementation guides
HL7 published CRD 2.2.1, DTR 2.2.0, and PAS 2.2.1 as coordinated Standard for Trial Use releases.
R1 launches Phare OS-powered prior authorization
R1 introduced a provider-side offering that combines requirement determination, documentation and submission automation, status tracking, EHR completion, payer intelligence, and human operations.
Humana targets fewer outpatient requirements and faster electronic decisions
Humana said it would remove approximately one-third of outpatient requirements, decide at least 95% of complete electronic requests within one business day, and launch a national gold-card program in 2026.
Latitude Health announces an integrated GuidingCare workflow
Latitude stated that GuidingCare customers can use its intake, review-intelligence, and performance capabilities through an API-based integration that returns key outputs to the core platform.
Availity and Onyx launch a joint CMS-0057 platform
The partnership combines Onyx FHIR infrastructure with Availity network connectivity for required payer APIs, prior authorization, data exchange, and reporting.