The federal agency running Medicare's experimental AI prior authorization program sent corrective action demands to four of its six contracted AI vendors within the first three months of operation — and disclosed none of it publicly, even as officials defended the…
Medicare paid one provider $4,701 for a drug administration that should’ve brought $3,462. The provider used the wrong billing code, producing a $1,239 overpayment. A federal watchdog caught it. Taxpayers should expect the payment system to catch mistakes like that before the money…
Seniors just got another reason to hate AI. The government is piloting a federal program that uses artificial intelligence to help decide what care to approve or deny. Medicare is included in the test program — dubbed the Wasteful and Inappropriate…
Centene, one of the nation's largest Medicaid insurers, will launch a gold card program in November that lets more than 160,000 qualifying providers use a simpler process for select outpatient services, the company announced in a news release on Oct. 13. Instead…
Healthcare leaders should be preparing now for important changes in prior authorization and other areas of healthcare. CMS will retain the historical reward factor for the 2027 Star Ratings instead of implementing the previously planned Health Equity Index reward. Plans and…
Insurance Business Health plans have 10 weeks to meet the prior auth API deadline, and the burden hasn’t eased yet The partnership is designed for a specific regulatory moment. The Centers for Medicare and Medicaid Services (CMS) finalized the Interoperability and…
HHS is a U.S. executive department that touches the lives of nearly all Americans by protecting your rights, research, food safety, health care, aging, and much more. HHS is advancing the Make America Healthy Again agenda by putting nutrition at the…
XiFin’s 2026 Payor Denial Impact Report finds that lab denial rates rose 40%. Empower AI Appeals makes previously cost-prohibitive appeals practical to pursue while reducing manual appeal preparation time by up to 90%. Key findings of the 2026 Payor Denial Impact Report Denials rose…
A senior federal health official has acknowledged that Medicare's experiment with AI-assisted prior authorization is falling short. "There are a lot of things about WISeR that are not working," Centers for Medicare & Medicaid Services (CMS) Deputy Administrator Kimberly Brandt said…
Survey data show that delays, denials and added steps tied to prior authorization are worsening patient outcomes and creating frustration — but AI may help streamline the process. As prior authorization (PA) becomes more entrenched in U.S. health care, a growing…
Prior Authorization and Denials in Medicare Advantage: the news, the names and what changed.
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