HEALTH CHAIN INSIGHTS
Preparing for Mandated 2026 CMS Interoperability Requirements
November 27, 2023 | 2-minute read
During the next two years, Medicare Advantage plans and other impacted++ plans will prepare to implement several CMS mandates. One of the notable patient-facing requirements concerns prior authorization (PA). The requirement’s intent is to help patients better understand their insurance company’s PA processes and the potential impact on their health care. The table below highlights relevant Health Chain products that health plans should consider implementing to:
Ensure compliance with CMS regulations
Improve plan member satisfaction
Streamline provider reimbursement and claims processing
| Mandated 2026 Patient Access Prior Authorization (PA) Requirements |
|---|
| PA status Date of PA approval or denial Date or circumstance under which the PA ends Items and services approved The quantity used to date under the PA, excluding PA decisions for drugs |
| Health Chain Products Supporting CMS 2026 Interoperability Requirements |
|---|
| HC Prior Authorization Suite Omega Patent Access App Plasma Claim Connect Centaur Payer to Payer Hub |
| ++ Medicaid Managed Care Plans , Children’s Health Insurance Program (CHIP) Managed Care Entities, State Medicaid and CHIP Fee-for-Service (FFS) Programs, and Qualified Health Plan (QHP) Issuers on the Federally Facilitated Exchanges (FFEs) |
