Follow the rules. Understand the workflow. Protect access to care.
Reporting on federal rules, payer operations, clinical-review models, transaction standards, and the systems moving authorization work between organizations.
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-0062-P would bring drug authorizations into a broader interoperability framework while also proposing updated standards and transaction requirements.
The March 31 reporting milestone creates a new, imperfect public evidence layer for examining payer authorization volume, outcomes, and decision timeframes.
CMS now requires MA organizations to submit information about internal coverage criteria used by the organization or its delegates for Part C prior authorization.
The initial Decision Intelligence Ecosystem connects Anterior, Latitude Health, and Case Health AI to GuidingCare, signaling a modular market for clinical review intelligence.
The three Da Vinci implementation guides define connected but distinct stages for discovering requirements, assembling documentation, and exchanging authorization requests and responses.
The provider-side offering combines rules, payer connectivity, automation, EHR completion, and human operations across determination, submission, and follow-up.
Beginning March 7, 2026, EviCore took on additional inpatient and outpatient authorization categories for specified Cigna Healthcare plans.
The joint offering pairs Availity's payer-provider network with Onyx's FHIR platform for payer API, data transformation, prior authorization, and reporting requirements.
The payer committed to removing about one-third of outpatient prior-authorization requirements, expanding one-day decisions, and launching a national gold-card program.
The federally named version becomes required January 1, 2028 and includes specific electronic prior-authorization transactions alongside broader e-prescribing changes.
