CMS Finalizes Rule to Simplify Payer-Provider Disputes Under No Surprises Act
Katie Adams / medcitynews - CMS finalized a new rule aimed at streamlining the No Surprises Act’s overwhelmed arbitration system. Provider groups largely welcomed the reforms — though some industry leaders said additional changes are still needed to address alleged misuse and improv…
AI Summary: The Centers for Medicare & Medicaid Services finalized a rule to simplify payer‑provider disputes under the No Surprises Act, updating the dispute resolution process and implementing a payer registry and portal changes. The aim is to reduce administrative friction, speed dispute handling, and make billing arbitration less of an endurance sport for providers and insurers.
CMS launches initiative to speed electronic prior authorization adoption
Emily Olsen / healthcaredive - The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.
AI Summary: CMS launched a national initiative to accelerate adoption of electronic prior authorization, recruiting major health‑IT vendors and health systems to pilot interoperable digital workflows. The program aims to cut paperwork and speed care decisions by automating approvals, though providers warn integration challenges and real‑world impact will take time to materialize.
- AI and automation firms reshaping prior authorization workflows (4)
- CMS' national push to accelerate electronic prior authorization (3)
- Policy fights, insurer delays and patient impact of prior auth (4)
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AI and automation firms reshaping prior authorization workflows
CMS' national push to accelerate electronic prior authorization
Policy fights, insurer delays and patient impact of prior auth
All Other Stories
Centene raises 2026 guidance with strong Q1 revenue, earnings results
fiercehealthcare - Centene kicked off the first quarter with better-than-expected revenue and adjusted earnings results, signaling a recovery from a rough 2025 as the insurer makes progress in managing medical costs.
AI Summary: Centene lifted its 2026 outlook after reporting robust first-quarter revenue and results, signaling confidence in managed care performance and enrollment trends. The company cited favorable operational metrics and market dynamics that supported the guidance bump, reassuring investors even as broader industry headwinds remain in play.
CMS to require states to audit Medicaid providers
Kristin Kuchno / beckershospitalreview - CMS Administrator Mehmet Oz, MD, said his administration will require all states to audit healthcare providers to address alleged Medicaid fraud, Politico reported April 21. Dr. Oz unveiled the plan at Politico’s Health Care Summit. Beginning this week, C…
AI Summary: CMS is requiring states to audit Medicaid providers as part of a new oversight initiative aimed at tightening program integrity and provider revalidation. The policy has sparked high‑level calls for nationwide reviews and a proposed 50‑state audit effort, signaling heightened federal scrutiny and potential changes to enrollment, billing and provider eligibility processes.
Baylor Scott & White Health Plan to exit Medicaid, individual markets; cut 321 jobs
Jakob Emerson / beckershospitalreview - Baylor Scott & White Health Plan said April 14 it will exit the Texas Medicaid managed care market and discontinue its individual marketplace plans, affecting roughly 225,000 members and eliminating 321 jobs statewide, according to the Dallas Morning News…
AI Summary: Baylor Scott & White announced it will leave Medicaid individual markets, a move that will shed hundreds of jobs and reshape coverage options for affected enrollees. The decision highlights ongoing financial pressures in public‑program participation and raises practical concerns about access continuity for people reliant on those plans.