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Prior authorization (PA) processes have traditionally been a pain point in healthcare, often leading to delays in care, administrative burdens, and frustration for both patients and providers. Recognizing the need for improvement, health plans across the country have committed to streamlining and si...
23 Jun, 2025
The Centers for Medicare & Medicaid Services (CMS) is in the early stages of exploring reforms aimed at creating more uniform prior authorization policies across health insurance plans. Among the innovations being considered is the incorporation of automation into coverage determinations, a developm...
20 May, 2025
The U.S. healthcare payer market is on the cusp of significant evolution, with Gartner forecasting an 8.5% growth in enterprise IT spending for this sector in 2025. This increase will drive total spending to $62.4 billion, an investment pattern that underscores the strategic importance of technology...
13 Mar, 2025
For Medicare Advantage (MA) plans, stricter quality thresholds from CMS continue to raise the bar for star ratings, making it harder for plans to achieve high scores. In 2025, the average MA Star Rating dropped from 4.07 in 2024 to 3.92, continuing a three-year downward trend. Additionally, only 40%...
13 Feb, 2025
Artificial intelligence (AI) has undeniably become a game-changer in various aspects of healthcare, offering unprecedented efficiency and speed. Among its many applications, AI holds significant potential in streamlining the claims denial and prior authorization processes that healthcare payers mana...
14 Jan, 2025
The introduction of the 2027 Interoperability and Prior Authorization Rule (CMS-0057-F) by the Centers for Medicare & Medicaid Services (CMS) heralds a pivotal shift in how healthcare payers must operate across the U.S. This transformative policy is set to redefine data sharing and streamline prior ...
14 Nov, 2024
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