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CMS recently finalized the Interoperability and Prior Authorization Final Rule. This final rule establishes requirements for Payors to streamline the prior authorization (PA) process. While prior authorization can help ensure medical care is necessary and appropriate, providers have been vocal that it is often an obstacle to necessary patient care when providers are forced to navigate complex and widely varying Payor requirements or face long waits for decisions. Beginning primarily in 2026, impacted Payors will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services.

Areas Covered

Understand the CMS Final Rule and what it means for Providers.
Understand ways to reduce the prior authorization burden.
Understand practice operations that can make your prior authorization process more efficient.
Understand the advantages and disadvantages of the myriad Prior Authorization submission methods.
Understand the procedures and medications that are likely to trigger prior authorization requirements.
Understand how to respond to an inappropriately denied prior authorization.

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