Tag: Prior Authorization
In brief: Benefit manager acquisition, prior auth deadline, provider revalidation
May 22, 2026HME News Staff
MIRAMAR, Fla. – Integrated Home Care Services has acquired Dina Care, combining an in-home benefit manager with an artificial intelligence (AI)-enabled care coordination and referral management platform.
Together, the companies say they form the first comprehensive in-home benefit management and technology platform for health plans and risk-bearing organizations.
“Given the mounting pressures on health plans and risk-bearing organizations—to improve outcomes, member experience,...
CMS extends prior authorization exemption deadline
May 20, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) has extended the deadline to opt out of prior authorization and continue submitting requests to May 26, AAHomecare reports.
This extension only applies to suppliers that received a letter from the DME MACs in early March regarding their prior authorization exemption status.
The updated MAC notice specifies:
If you reached exemption and want to continue submitting prior authorization requests, you must submit the opt-out...
CMS takes next step to improve prior authorizations
May 11, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services has added electronic prior authorization to its Health Tech Ecosystem. The agency says health systems, hospitals, physician practices, electronic health record (EHR) vendors and digital health developers are now joining payers as a unified coalition aligned around improving electronic prior authorization.
Working groups have been formed, vendors work to streamline process
Committed working groups across these stakeholders will...
In brief: ACU-Serve’s executive boost, CMS’s next prior auth move, McKesson’s & Medline’s results
May 11, 2026HME News Staff
AKRON, Ohio – ACU-Serve has appointed Natasha Baria Mehta as president, a strategic leadership addition that the company says reflects its continued investment in growth, operational excellence and innovation across the health care revenue cycle management (RCM) industry.
In this role, Mehta will oversee operational strategy, organizational performance and long-term growth initiatives across ACU-Serve’s HME, infusion and home health divisions. She will focus on strengthening operational...
Health plans to standardize prior auth processes
April 27, 2026HME News Staff
WASHINGTON – Leading health plans will adopt a standardized approach for providers submitting electronic prior authorization requests for the majority of medical services, which they say will accelerate patient access to care and reduce administrative burdens for providers.
The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs. These services span commercial...
In brief: Dems drop MA bill, Soleo launches new brand, VGM partners with HME360
April 24, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
Dems introduce bill to eliminate prior auths for MA plans
April 23, 2026HME News Staff
WASHINGTON — Reps. Pramila Jayapal, D-Wash., and Ro Khanna, D. Calif., have introduced the Stop Deadly Denials Act to no longer allow Medicare Advantage plans to require prior authorization for necessary medical items and services.
The legislation would ensure patients are able to receive fair affordable coverage without added administrative burdens from prior authorization that frequently block care.
“Medicare DisAdvantage makes it harder for patients to get the care they need...
In brief: Health care spending, prior auth list, fraud division
January 16, 2026HME News Staff
WASHINGTON – Health care spending in the U.S. reached $5.3 trillion and increased 7.2% in 2024, similar to 7.4% in 2023, as increased demand for health care influenced this two-year trend, according to a new article in the journal Health Affairs.
Health care spending growth continued to outpace overall economic growth
As a result, the health care share of the economy increased from 17.7% in 2023 to 18% in 2024. In 2024, the share of...
As CMS turns to AI, GenHealth.ai says it’s built for what’s next
July 25, 2025Liz Beaulieu, Editor
BOSTON – GenHealth.ai believes it’s in the right place at the right time following CMS’s recent decision to use artificial intelligence (AI) to expedite the prior authorization process for traditional Medicare.
The company, which entered the home medical equipment (HME) market earlier this year, says it leverages recent advancements in AI and large language models (LLMs), along with deep integrations into existing EMR and billing systems, to automate prior authorization...
Prior authorizations: Insurer pledges, tech plays & exemption pathway
July 3, 2025Liz Beaulieu, Editor
WASHINGTON – In about a one-week span, the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) proposed three new initiatives that seek to improve and modernize the prior authorization process. Industry stakeholders say the initiatives – while some are geared more toward physicians and are smaller in scale – could have a positive impact on HME providers.
All in late June:
HHS and CMS announced that major health...