Staff Contact: Andrew Wheeler
CMS finalized a rule that advances interoperability and improves prior authorization processes for Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program Fee-for-Service programs, Medicaid managed care plans, CHIP managed care entities and Qualified Health Plan issuers on the Federally Facilitated Exchanges. The major sections of changes include the following.
- decreasing the turnaround time between prior authorization requests and insurer determinations from 14 days to seven days for standard requests, and 72 hours for urgent requests
- public reporting of prior authorization metrics on the insurer’s website
- include certain prior authorization details through Patient Access, Provider Access, Insurer-to-Insurer and Prior Authorization application programming interfaces
MHA published an issue brief with additional information.