Prior Auth Monitor

Prior Auth Monitorhttps://priorauthmonitor.com/2026-07-19T14:00:00.000ZCMS expands the DMEPOS prior-authorization list for April 2026https://priorauthmonitor.com/news/cms-dmepos-list-expands-april-2026/2026-07-19T14:00:00.000Z2026-04-13T14:00:00.000ZPrior Auth Monitor Research Desk

Seven additional HCPCS codes became subject to nationwide prior authorization as a condition of payment, while CMS also introduced an exemption path for qualifying suppliers.

CMS proposes extending electronic prior authorization requirements to drugshttps://priorauthmonitor.com/news/cms-proposes-drug-prior-authorization-rule/2026-07-19T14:00:00.000Z2026-04-10T16:00:00.000ZPrior Auth Monitor Research Desk

CMS-0062-P would bring drug authorizations into a broader interoperability framework while also proposing updated standards and transaction requirements.

CMS reaches its first public prior-authorization metrics deadlinehttps://priorauthmonitor.com/news/cms-first-public-prior-authorization-metrics/2026-07-19T14:00:00.000Z2026-03-31T15:00:00.000ZPrior Auth Monitor Research Desk

The March 31 reporting milestone creates a new, imperfect public evidence layer for examining payer authorization volume, outcomes, and decision timeframes.

Medicare Advantage organizations face a new utilization-management data submissionhttps://priorauthmonitor.com/news/cms-part-c-um-annual-data-submission-2026/2026-07-19T14:00:00.000Z2026-03-25T16:00:00.000ZPrior Auth Monitor Research Desk

CMS now requires MA organizations to submit information about internal coverage criteria used by the organization or its delegates for Part C prior authorization.

HealthEdge opens GuidingCare to multiple utilization-management AI partnershttps://priorauthmonitor.com/news/healthedge-guidingcare-decision-intelligence-ecosystem/2026-07-19T14:00:00.000Z2026-02-25T15:00:00.000ZPrior Auth Monitor Research Desk

The initial Decision Intelligence Ecosystem connects Anterior, Latitude Health, and Case Health AI to GuidingCare, signaling a modular market for clinical review intelligence.

HL7 publishes coordinated 2026 updates to CRD, DTR, and PAShttps://priorauthmonitor.com/news/hl7-davinci-2026-prior-authorization-guides/2026-07-19T14:00:00.000Z2026-01-27T17:00:00.000ZPrior Auth Monitor Research Desk

The three Da Vinci implementation guides define connected but distinct stages for discovering requirements, assembling documentation, and exchanging authorization requests and responses.

R1 launches an end-to-end prior-authorization service on Phare OShttps://priorauthmonitor.com/news/r1-launches-phare-prior-authorization/2026-07-19T14:00:00.000Z2026-01-15T15:00:00.000ZPrior Auth Monitor Research Desk

The provider-side offering combines rules, payer connectivity, automation, EHR completion, and human operations across determination, submission, and follow-up.

Cigna expands EviCore's delegated utilization-management scopehttps://priorauthmonitor.com/news/evicore-cigna-expands-delegated-services-2026/2026-07-19T14:00:00.000Z2026-01-06T15:00:00.000ZPrior Auth Monitor Research Desk

Beginning March 7, 2026, EviCore took on additional inpatient and outpatient authorization categories for specified Cigna Healthcare plans.

Availity and Onyx combine network connectivity with CMS-0057 infrastructurehttps://priorauthmonitor.com/news/availity-onyx-cms-0057-platform/2026-07-19T14:00:00.000Z2025-08-06T15:00:00.000ZPrior Auth Monitor Research Desk

The joint offering pairs Availity's payer-provider network with Onyx's FHIR platform for payer API, data transformation, prior authorization, and reporting requirements.

Humana sets 2026 targets for fewer requirements and faster decisionshttps://priorauthmonitor.com/news/humana-2026-prior-authorization-commitments/2026-07-19T14:00:00.000Z2025-07-22T15:00:00.000ZPrior Auth Monitor Research Desk

The payer committed to removing about one-third of outpatient prior-authorization requirements, expanding one-day decisions, and launching a national gold-card program.

Pharmacy electronic prior authorization prepares for NCPDP SCRIPT 2023011https://priorauthmonitor.com/news/ncpdp-script-2023011-transition/2026-07-19T14:00:00.000Z2025-01-02T15:00:00.000ZPrior Auth Monitor Research Desk

The federally named version becomes required January 1, 2028 and includes specific electronic prior-authorization transactions alongside broader e-prescribing changes.