The passing of the 2024 CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) has set the healthcare industry on a path toward transformation. The rule isn’t just a compliance hurdle for health plans—it’s also a golden opportunity to drive innovation and improve patient care. While the market is aware of CMS-0057-F and its required changes, a meaningful push is still needed to get organizations to act now, especially with the initial implementation deadline of January 1, 2026 looming. Learn more about the requirements of the final rule here.
The 2024 CMS Interoperability and Prior Authorization Final Rule
The core of CMS-0057-F is reducing the burdens associated with prior authorization (PA). This administrative process has long been frustrating for healthcare providers, patients, and health plans. The rule responds to concerns about the inefficiencies and delays caused by traditional PA processes, which often involve cumbersome paperwork and lengthy approval timelines.
An American Medical Association survey found that the impact of traditional PA is significant:
While the rule introduces new requirements, it also allows health plans to streamline operations, improve collaboration with providers, and better align care with clinical best practices.
The shift toward intelligent prior authorization
One of the key provisions of CMS-0057-F is the shift from a transactional PA process to a more intelligent, streamlined approach that leverages technology. Alina Czekai, MPH, VP of Value-Based Care Strategy, explains that the rule provides an essential opportunity for health plans to move from “transaction-focused prior authorization” to “transformational utilization management.”
Adopting intelligent PA solutions that integrate real-time data and provide automated decision-making capabilities offers major benefits. They reduce administrative burdens, accelerate approval times, and help ensure decisions are based on clinical evidence, ultimately improving patient outcomes.
The shift toward intelligent prior auth for health plans represents an evolution toward a more efficient, provider-friendly model that aligns with the broader goals of value-based care. It’s not just about meeting the letter of the regulation but rather enhancing care delivery and supporting a more transparent healthcare system.
The “table stakes” and beyond
The clock is ticking as health plans focus on meeting CMS-0057-F requirements. The deadline for January 1, 2026, is fast approaching, and many organizations are still in the early stages of planning for or implementing solutions to address compliance. Procrastination could be costly.
While meeting the CMS-0057-F requirements is a critical first step, the rule’s provisions are just the beginning. These requirements represent “table stakes” for modern healthcare systems, and Cohere can do much more than just help you meet the rule’s baseline needs.
Our rapid implementation model is designed to help health plans quickly comply with the new regulation’s prior authorization components. Our streamlined approach ensures that health plans can get up and running with minimal disruption and easily meet the compliance deadline.
New partnerships and solutions: A growing market
Over the past six months, many solutions and partnerships have emerged that address the rule’s requirements. While this surge of new players is a positive sign, it also means a great deal of untested technology is entering the market. Health plans need to be cautious as they evaluate these solutions.
Unlike many new entrants, we have fully prepared our solution for this shift over time. Cohere supports these requirements and has been helping millions of PA requests a year, unlike newer solutions that are still in their early stages and haven’t been thoroughly tested in real-world environments.
Working with a proven partner is essential for health plans that are serious about meeting the rule’s requirements and improving provider collaboration. Our solution has a track record of success, with excellent feedback from providers who appreciate the ease of use and reduction in administrative burden. We’re not a “provider-unfriendly” vendor just spinning up a solution to meet the basic regulatory requirements—we’re a trusted partner that understands the needs of both health plans and providers.
Why partner with us?
As the industry continues to shift toward value-based care, health plans are under increasing pressure to deliver better outcomes while managing costs. Our solution helps you reduce the administrative burden associated with PA while ensuring that decisions are timely, data-driven, and evidence-based.
- Proven and tested technology: Unlike new solutions that are still being developed, our system has been tried and tested in real-world settings
- Provider-friendly: We’re a solution that providers trust and love, with high satisfaction rates and measurable reductions in administrative workload and burnout
- Meet deadlines: With our proven, timely implementation model for technology and services, health plans can meet the 2026 and 2027 deadlines without disruption
- Beyond compliance: While we’ll help you meet CMS-0057-F requirements, our solution offers much more value-based care, collaboration, and transparency
The road ahead
CMS-0057-F is a pivotal moment for healthcare, offering health plans the chance to streamline operations, reduce provider burden, and improve patient outcomes. However, health plans must move quickly and choose a partner with the experience, technology, and provider relationships to drive long-term success.
By implementing intelligent PA solutions today, health plans can ensure compliance and position themselves for success in a value-based landscape. So, as the deadline approaches, the question remains: Is your health plan ready to take the first step toward transformation?
Take the first step toward transformation today. Submit a request here to connect with one of our experts.
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