Search
AI is accelerating the volume of transactions without increasing efficiency, report finds.
The approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services.
Hospitals must balance financial pressure with clinician wellbeing as cost-first strategies are linked to burnout.
Cost control, Carelon integration and scaling AI are reasons for the company's confidence.
HHS is proposing to adopt certain HL7 FHIR standards and implement specifications for transactions related to prior authorizations.
The proposed rule would also make the Comprehensive Care for Joint Replacement (CJR) Model mandatory beginning on Oct. 1, 2027.
Providers and payers have two years to comply with the mandate the agency says will save $781 million a year.
Most providers say having the majority of their payers support the Prior Authorization API requirements is extremely important.
"Kill the clipboard" is a mantra of CMS as the agency advocates for patients to be able to scan a QR code to bring their data to their provider.
Health systems evaluating AI must look beyond datasets and algorithms to understand the assumptions and priorities embedded within the applications themselves.
