You have seen the headlines about the new proposed rule, Advancing Interoperability and Improving Prior Authorization (PA) Processes, (CMS-0057-P) from The Centers for Medicare & Medicaid Services (CMS). 

But what components of the proposed rule are positive? What will serve as a strategic lever for better payer-provider collaboration, interoperability, transparency, and patient care? And what parts of this rule could be improved? 

Here’s a quick summary of the public comments Cohere Health submitted on the proposed rule:

  • Cohere supports CMS requiring health plans to:
    • Build and maintain a Fast Healthcare Interoperability Resources (FHIR) application programming interface.
    • Include a specific reason when denying a PA request.
    • Publicly report certain PA metrics annually on their website.
  • Cohere recommends:
    • Requiring a proportion of PA requests to be auto-decisioned to drive shorter turnaround times.
    • Considering “green lighting” high-performing providers instead of gold carding them.

Cohere already enables health plans to meet–and in most cases, exceed–the forthcoming requirements proposed by CMS.

Understand more about how forward-thinking health plans can achieve compliance, and more!

Stay tuned for more about the brand new related CMS rule, the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F).

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