Health Insurers to Face Data Sharing, Coverage Requirements

A final rule released Wednesday imposes new requirements designed to enhance the electronic exchange of health-care data, and improve the prior authorization process for managed care plans offered under Medicare, Medicaid, and the Children’s Health Insurance Program.

The final rule (RIN: 0938-AU87) from the Centers for Medicare & Medicaid Services requires certain payers to implement an electronic prior authorization process, shorten the time frames for responding to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent.

The changes, along with reduced burden on patients, providers and insurers, are expected to save $15 billion ...