7 prior authorization updates

From Point32Health announcing home health prior authorization cuts to a state's proposed gold carding program legislation failing, here are seven updates on prior authorization that Becker's has reported since March 21.   

1. CMS issued its final 2025 Medicare Advantage and Part D rule April 4, setting new standards around marketing, broker payments, and prior authorization.

2. Epic's Payer Platform has expanded to include Cohere Health's artificial intelligence-driven prior authorization solutions.

3. Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan, is updating prior authorization for home health services as it conducts a larger review of its requirements. 

4. CFOs cited "onerous prior authorization requirements" as a top reason why collecting from Medicare Advantage plans is more difficult than it was two years ago, according to a report from the Healthcare Financial Management Association and Eliciting Insights. 

5. Proposed legislation in Kentucky to create a gold carding program for prior authorization requests failed

6. About 15% of all claims submitted to private payers for reimbursement are initially denied, including 3.2% that are pre-approved to move forward through the prior authorization process, according to a report from healthcare solutions company Premier. 

7. Becker's spoke with Alexandra Mugge, chief health informatics officer at CMS, about the CMS Advancing Interoperability and Improving Prior Authorization Processes final rule.   

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