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Simplification Push Yields Major PriorAuthorization Win

Knowledge Center Simplification Push Yields Major PriorAuthorization Win January 25, 2024 Family physicians got several administrative simplification wins in CMS’ Jan. 17 finalization of a long-anticipated prior authorization rule that reflects the AAFP’s staunch advocacy. As the Academy called for following CMS’ December 2022 proposal, the final rule will expand and strengthen the electronic prior…

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How CMS’ prior authorization rule will affect insurers

Knowledge Center How CMS’ prior authorization rule will affect insurers January 23, 2024 The biggest adjustment involves altering processes so prior authorization decisions are automatically embedded into electronic health records. The change will be a dramatic one: Prior authorization represents one of the most manual processes carried out by health insurers, according to a 2022 survey…

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CMS finalizes rule setting prior authorization deadlines for payers

Knowledge Center CMS finalizes rule setting prior authorization deadlines for payers January 19, 2024 To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization decisions within three days for urgent requests and seven days for standard requests…

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Health care organizations praise CMS new rules on prior authorizations, interoperability

Knowledge Center Health care organizations praise CMS new rules on prior authorizations, interoperability January 17, 2024 On Jan. 17, 2024, the U.S. Centers for Medicare & Medicaid Services (CMS) announced regulations aimed at speeding up the prior authorization (PA) process and promoting greater interoperability. Known as CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), there…

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Edifecs to Speak on the Power of Artificial Intelligence at 2023 WEDI National Conference

Knowledge Center Edifecs to Speak on the Power of Artificial Intelligence at 2023 WEDI National Conference November 6, 2023 BELLEVUE, Wash.–(BUSINESS WIRE)–Edifecs, Inc., a global health information technology solutions company, is participating in multiple sessions at the Workgroup for Electronic Data Interchange (WEDI) 2023 National Conference Nov. 6-9 in Washington D.C. Dr. Summerpal Kahlon, M.D.,…

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Healthcare IT today Bonus Features

Knowledge Center Healthcare IT today Bonus Features September 25, 2023 WEDI called to “indefinitely postpone” the No Surprises Act Convening Provider Requirement in a comment letter, given “almost insurmountable challenges” in identifying providers, facilities, and the ability to collect and transfer good faith estimates.   Healthcare IT today Bonus Features Back to Knowledge Center Categories…

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Healthcare Orgs Address Price Transparency, 340B Policies in OPPS

Knowledge Center Healthcare Orgs Address Price Transparency, 340B Policies in OPPS September 15, 2023 Hospital and specialty groups are urging CMS to amend aspects of the CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule, including 340B Drug Pricing Program policies and price transparency requirements. The American Hospital Association (AHA), Workgroup for Electronic Data Interchange…

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Better data exchange is key to improving patient health outcomes

Knowledge Center Better data exchange is key to improving patient health outcomes August 31, 2023 Interoperability and related compliance mandates are not new, though the landscape is ever changing. Without these two key components, progress is at stake. No one wants to return to the Wild West of health data and record keeping. Fortunately, the…

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Congress Proposes Relief on Prior Authorization, but CMS is Ahead of the Game

Knowledge Center Congress Proposes Relief on Prior Authorization, but CMS is Ahead of the Game August 22, 2023 A couple of new bills, or rather, retreads of old bills, demonstrate increased congressional interest in reforming prior authorization (PA) under Medicare Advantage (MA). The Price Transparency bill’s Title III section (“Establishing Requirements with Respect to the…

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Edifecs to Showcase Prior Authorization Solution at WEDI Summer Conference 2023

Knowledge Center Edifecs to Showcase Prior Authorization Solution at WEDI Summer Conference 2023 July 31, 2023 -Edifecs, Inc., a global health information technology solutions company, is participating in multiple sessions at the virtual Workgroup for Electronic Data Interchange (WEDI) 2023 Summer Conference, August 1 – 2. Kevin Day, principal business advisor at Edifecs, and AVP…

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