Earlier this year, CMS released the Advancing Interoperability and Improving Prior Authorization Processes final rule to address certain operational and technical aspects of prior authorization for “Impacted Payers” across Medicare Advantage plans, Medicaid, Fee-for-Service programs and more. AAHKS provided input on several prior authorization open comment periods over the last few years, leading to some of the following changes included in this final rule: Impacted Payers (except QHPs) must respond to prior authorization requests within 72 hours of expedited requests and seven calendar days of standard requests, must provide a specific reason for denied prior authorization decisions, annually publicly report certain prior authorization metrics and must implement and maintain a Prior Authorization Application Programming Interface (“API”) to enable automation of certain processes for providers and to facilitate the exchange of prior authorization requests and decisions from provider electronic health records and practice management systems, among other provisions. Read the full summary of the final rule provisions and AAHKS’s impact here. 

Close Bitnami banner