New CMS tech rule could speed up prior auth — but leaves out Medicare Advantage

Article Overview

This article covers a CMS proposed rule aimed at modernizing prior authorization workflows through electronic data exchange and interoperability standards. It is relevant to providers, billing teams, revenue cycle leaders, payer operations staff, and health IT vendors who track administrative process changes affecting prior authorization. The discussion focuses on the types of plans and programs affected, the technical APIs and standards CMS wants adopted, and the significant omission of Medicare Advantage from the proposal.