A new federal rule seeks to reduce Medicare Advantage insurance plans' prior authorization burdens on physicians while also ensuring that enrollees have the same access to necessary care that they would receive under traditional fee-for-service Medicare. The prior authorization changes, announced this ...
CMS sought to address concerns surrounding what the term “course of treatment” meant in the proposed rule. The agency said that the rule requires approval of a prior authorization request for a course of treatment that must be valid for as long as it is medically necessary to ens...
Lawmakers and beneficiary advocates are pressing HHS to pause the impending expansion of a Medicare model that relies on prior authorization to reduce improper ambulance payments, arguing that unless gaps in the program are filled with non-emergency transport, going nationwide will harm patients with ...
The insurer will also be required to make prior auth decisions about behavioral health services within five days and accept or reject a provider’s request to join the company’s network within 45 days. Interestingly, the company will share “nonpublic trade secret information” with the state’s...