The final rule largely resembles its proposed form with some key additions, as follows:

• The implementation deadline for FHIR-based APIs is now January 2027
• Enforcement of HIPAA X12 278 standard for interoperability APIs
• A publishing deadline for the first prior authorization metrics
• Additional components of patient access, provider, and payer-to-payer APIs
• An exception to turnaround time requirements (TAT)

Having served as senior advisor to former CMS Administrator Seema Verma, I’m excited to see CMS leading the charge in prior authorization reform.

The focus on regulatory compliance is kicking off an exciting new chapter and setting the stage for greater change in healthcare.

Check out this article to see more about the final rule, and learn how intelligent prior authorization can help usher your organization into this new era.

News You Can Use

🏛️ CMS
Finalized Rule to Expand Access to Health Information and Improve the Prior Authorization Process

💡 Cohere Health
Four things you need to know about the final CMS prior authorization rule

Before You Go

What’s in and what’s out for 2024 with Cohere Health:

👍 In:

• Using AI responsibly
• Patients getting quality care faster
• Less admin burden for providers
• More personalized care
• Prior authorization = driver for better outcomes

👎 Out:

• Care delays associated with prior authorization
• Phone tag for missing information
• Using AI to deny auth requests
• Extra administrative work
• One-size-fits-all care
• Prior authorization = manual and time-consuming