CMS Final Rule Eliminates Fax and Mail for Claims Attachments CMS finalizes electronic claims attachment and e-signature standards, replacing fax and mail to reduce administrative
By March 31, 2026, impacted payers must publicly post prior authorization metrics for calendar year 2025 under CMS-0057-F. That includes data tied to approval and denial rates, appeal outcomes, turnaround times, and the items and services subject to prior authorization.
CMS has issued new guidance strengthening patient protections and accountability in the organ donation system, with implications for payers around transplant network oversight, OPO recertification, and member care navigation through 2027.
Industry Watch Alert Home The Centers for Medicare & Medicaid Services announced it is extending the application deadline for prescription drug manufacturers to participate in
The Trump Administration announced expanded fraud prevention actions across Medicare and Medicaid, signaling a shift toward real-time oversight, increased transparency, and heightened program integrity expectations for payer organizations.
CMS proposes 2027 Exchange regulations focused on lowering premiums, expanding plan flexibility, and strengthening subsidy oversight and program integrity for payers.
The Consolidated Appropriations Act, 2026 extends Medicare telehealth and hospital-at-home programs while delaying Medicaid DSH cuts, reinforcing long-term oversight and utilization management considerations for healthcare payers.
An executive analysis of the White House Great Healthcare Plan proposal, what it could mean for payers and providers, current congressional status, and realistic timelines for potential healthcare policy changes.
Get turnkey toolkits, facts, and leadership actions for World NTD Day (Jan 30) to advance global health equity and ESG goals across your organization.
CMS is testing whether international reference pricing can be operationalized within Medicare Part B without degrading access or quality. If finalized, the GLOBE Model would become one of the most consequential mandatory drug pricing demonstrations implemented to date.
