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Prior Authorization Targeted by CMS Medicare - JDSUPRA
Under the guise of fraud and waste prevention, the Centers for Medicare & Medicaid Service (CMS),along with dozens of large healthcare insurance companies, have revealed forthcoming changes to the “Prior Authorization” process. Prior Authorization is a process used by various Medicare Advantage insurers to require pre-approval of certain healthcare services.
CMS recently announced its “WISeR” program, which uses artificial intelligence technologies to expedite prior authorizations while simultaneously reducing instances of Medicare fraud and waste. At the same time, many large insurers have pledged to voluntarily reduce their prior authorization processes, originally designed to reduce unnecessary care, but which also results in needed medical care being denied, as explained in this JDSUPRA article.
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