Prior Authorizations (PAs) have their place in focusing on medical necessity and controlling the upward rise in premium costs. But the administrative expense to providers and the potential delays in care for patients often overshadow the intent of PAs.
Now, CMS seeks to bring more transparency to the health insurance provider approval processes as well as better connect and inform health insurance providers, care providers, and patients about PAs. But because the rule was issued in the previous administration’s last days, stakeholders had little time to assess and respond. New leadership is conducting its own review of the rule, and changes could be made. We will examine payer, provider, and industry group concerns and talk about their implications.
This webinar will explore the breadth of the CMS Prior Authorization Rule, the deadlines it imposes, and health insurance providers’ concerns. We will call out important technologies available today to assist plans in complying with the new CMS rule.
Director of Business Development
Tom is a seasoned healthcare professional with more than 20 years of industry experience spanning payer, clearinghouse, pharma, and medical device verticals. At DrFirst, Tom is instrumental in supporting the build of technology products that address payers’ needs for interoperability and administrative efficiencies. Prior to joining DrFirst, Tom held business development leadership positions at Payspan, Physician Practice Specialists, and Availity where he launched their HL7 toolset.
Vice President Client Strategy and Business Development, Payer
Jenny has extensive background in healthcare technology with more than 25 years of experience spanning risk adjustment, population health and quality gap closure, business intelligence and predictive modeling, payment integrity, post-acute and chronic care management. Prior to joining the DrFirst, Jenny held leadership positions at Hinduja Global Solutions, Matrix Medical Network, Availity, Cotiviti and Optum, and started her career at BlueCross BlueShield of Georgia.