The Medicare Access and CHIP Reauthorization Act, or MACRA, is coming soon, and with it CMS's Quality Payment Program, which requires providers who bill Medicare more than $30,000 a year to report ...

In 2026, out-of-network providers face urgent changes as CMS-0057-F enforces strict prior authorization timelines and API adoption, while Availity Essentials adds new self-service tools. AI-powered ...

The CMS is once again tackling prior authorization in its new rule proposed Tuesday. Prior authorization, a process in which a physician must get the green light from an insurer for medication or ...

A large portion of payers and providers have not started or are partially through implementing CMS API requirements, with compliance due by January 1, 2027. Key challenges include funding, developing ...

The 2026 CMS Prior Authorization Final Rule is reshaping healthcare operations by shortening decision timelines, requiring specific denial reasons, and increasing transparency. Providers are turning ...