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Knowledge Center

Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

March 8, 2022

WEDI submitted comments in response to a Request for Information (RFI) from the Centers for Medicare & Medicaid Services (CMS) on challenges associated with the No Surprises Act (NSA). While reiterating general support for the intent of the legislation, WEDI outlined burdens the industry faces implementing the Good Faith Estimation and the Patient-Provider Dispute Resolution Process provisions of the NSA, including the unpredictability of services, the application of potential discounts, the difficulties associated with the “convening” provider/facility, the required response times, and others. Thanks to board chair Nancy Spector and her colleagues from the AMA, board member and NSA Task Group Co-Chair Terry Cunningham (AHA), and his follow Co-Chairs Beth Davis (Allscripts Payerpath), Stanley Nachimson (Nachimson and Associates), and Tom Wilder (United Healthcare) for their input and edits to the comment letter.

Use the link below to read the entire comment letter.

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