By Sanjay Subramanian – Some of the most expensive work in healthcare is the work no one counts as care. Physicians and their teams chase authorization status, resubmit records, clarify denial reasons, and explain coverage confusion to patients.
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By Dr. Apurva Jain – The CMS-0057 Interoperability and Prior Authorization Final Rule released in January 2024 and implemented between January 2026 and January 2027 is a welcomed step in the modernization of prior authorizations (PA). In addition to new measures such as promoting and standardizing digital workflows….
By Deepak Kumar – Every physician knows the frustration. A patient needs a medication or procedure. The clinical case is clear. But before care can begin, someone on staff must navigate a phone tree, fax a form, wait days for a response, and then, far too often, start the process over after a denial.
The Centers for Medicare & Medicaid Services, through its Health Tech Ecosystem, is advancing its electronic prior authorization efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements.
By Sanjay Subramanian – Why Real-Time Approval Requires Rethinking Payer Infrastructure – Prior authorization exists for a reason; it requires providers to obtain approval from a patient’s health plan before certain services or treatments are delivered. Insurers view it as a way to confirm medical necessity and control costs.
CMS has released the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule (CMS-0062-P), continuing its efforts to improve electronic prior authorization so patients and providers can benefit from a more expeditious, transparent and reliable process.
By Jen McCormick and David Ostrowsky – Prior. Authorization. Lumped together, the two words have long been the bane of patients’ experience in navigating an often-byzantine healthcare system. Whether you’re a patient with diabetes waiting ever-so patiently for insulin or one suffering from multiple sclerosis and in dire need of…
By Tony Schueth – The CMS pledge is big on vision but light on details about execution. That’s not unusual. Pledges are intended to inspire and drive change and innovation, but they do not provide a step-by-step playbook for achieving a goal.
By Mary Griskewicz – At its core, HTI-4 is about making prescribing and medication access more real-time, transparent, and aligned with patient needs. It updates health IT certification criteria in three key areas: electronic prescribing, real-time prescription benefit (RTPB), and electronic prior authorization (ePA).