The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is driving some industry improvements in this area and there's a lot of opportunity for

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is driving some industry improvements in this area and there's a lot of opportunity for technologists to help implement it. While the rule mostly only applies to Medicare Advantage health plans, many payers are voluntarily implementing the same HL7 Da Vinci Project Prior Authorization Burden Reduction APIs across all lines of business. These APIs give providers standard ways to check whether prior authorization is required for a plan of treatment, find out exactly what documentation the health plan requires, and then submit the prior auth request. This won't solve the problem of improper denials but will at least reduce delays and errors. https://www.cms.gov/priorities/burden-reduction/overview/interoperability/policies-regulations/cms-interoperability-prior-authorization-final-rule-cms-0057-f https://www.cms.gov/priorities/burden-reduction/overview/int...