CMS finalizes prior authorization rule for medical claims

CMS recently finalized a prior authorization rule for medical claims related to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs), (collectively “impacted payers”). Notably, the policies in CMS’ final rule do not apply to prior authorization decisions for drugs.

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, Children Health Insurance Program , Health Plan , Medicare Advantage , Health Insurance Program , Qualified Health Plan , Federally Facilitated Exchanges , Provider Access , United States Core Data , Patient Access ,