What You Should Know:
- The U.S. Department of Health and Human Services (HHS) has released a new final rule, the Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization (HTI-4).
- The rule implements policies to support the goal of processing prior authorizations in real time during patient care encounters and is a critical step in advancing interoperability for patients, providers, and payers to ease
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Prior Authorization
Humana Accelerates Prior Authorization Reforms, Pledges to Cut Requirements and Expedite Approvals
What You Should Know:
- Humana Inc. announced accelerated efforts to approve care requests as quickly as possible and reduce the administrative burden for physicians associated with prior authorization.
- These actions aim to streamline and reduce prior authorization requirements while preserving the system of checks and balances that protects patient safety for high-cost, high-risk treatments.
Prior Authorization Reform
Humana is working to reduce the "red tape" on prior
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ZeOmega Partners with Massachusetts Health Data Consortium to Launch Nation’s First Statewide FHIR-Based Prior Authorization System
What You Should Know:
- ZeOmega®, a population health and interoperability technology company announced it has been selected by the Massachusetts Health Data Consortium (MHDC), a nonprofit advancing health data sharing, to transform prior authorization and clinical data exchange across Massachusetts.
- The initiative creates the nation’s first statewide FHIR®-based system designed to streamline communication between payers and providers, reducing administrative burdens and
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What Are Healthcare’s Most Pressing Revenue Integrity Issues in The Remote-Work Era?
With more and more organizations merging for scale and sustainability, revenue cycle teams are being centralized, taking these critical personnel further away from physicians at the bedside. Remote teams are finding it harder than ever to collaborate with clinicians on critical functions.
Simultaneously, more revenue cycle functions are being automated as robotic process automation and generative AI evolves. With fewer administrative personnel in general — and even fewer
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Providers & Payers: Prepare Now for CMS Prior Authorization Final Rule
The new administration shed light on policy issues at the top of providers’ lists for 2025. While topics like physician burnout and Medicare payment reform were included, unsurprisingly, prior authorization remains at the forefront, as proven by entities like the American Medical Association, who represent more than 270K providers. Improvements in the prior authorization and interoperability space have been historically stalled due to lack of standard data and public reports, as technology
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Humata Health’s AI-Powered Prior Authorization Platform Now Available on Microsoft Azure Marketplace
What You Should Know:
- Humata Health, a provider of AI-powered touchless prior authorizations, today announced the availability of its platform in the Microsoft Azure Marketplace, an online store providing applications and services for use on Azure.
- The integration allows healthcare payers and providers seeking to automate prior authorization to leverage the productive and trusted Azure cloud platform, with streamlined deployment and management.
Transforming End-to-End
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85% of Cancer Patients Face Unnecessary Insurance “Red Tape” Due to Prior Authorization, Says New CancerCare Report
What You Should Know:
- A new national survey from CancerCare reveals how insurance utilization management practices, particularly prior authorization, create serious and stressful barriers to care for cancer patients. The report, titled "The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management," found that these requirements frequently delay diagnosis and treatment, adding significant "time toxicity" to patients' lives.
- The
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RISA Labs Raises $3.5M for AI-Powered Oncology Prior Authorizations Platform
What You Should Know:
- Cancer patients don’t just fight the disease - they fight the system. Today, life-saving treatments are routinely delayed by days or even weeks due to manual, error-prone workflows
- To solve this, RISA Labs has raised a $3.5M funding round to help healthcare organizations eliminate one of the most persistent barriers to timely cancer care: prior authorization delays. RISA Labs has already proven that faster care is possible by dramatically reducing manual
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WEDI Survey: Industry Readiness for CMS Interoperability and Prior Authorization Rule
What You Should Know:
- The Workgroup for Electronic Data Interchange (WEDI) has published the results of its baseline survey, assessing the healthcare industry's preparedness to meet the requirements of the Centers for Medicare & Medicaid Services (CMS) Advancing Interoperability and Improving Prior Authorization Final Rule (CMS-0057-F).
- This rule introduces new provisions aimed at increasing data sharing, including Patient Access, Provider Access, Payer-to-Payer,
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AI-Driven Prior Authorization Denials Raise Concerns Among Physicians, AMA Survey Reveals
What You Should Know:
- A new survey from the American Medical Association (AMA) reveals growing concern among physicians about the use of artificial intelligence (AI) in prior authorization decisions by health insurers.
- The survey found that 61% of physicians are worried that AI-powered tools are leading to an increase in prior authorization denials, potentially harming patients and contributing to unnecessary healthcare costs.
Prior Authorization Concerns
Prior
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