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CMS releases Interoperability and Prior Authorization Final Rule 

Impacted payers will be required to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests, according to a final rule released by the Centers for Medicare and Medicaid Services. Implementation and maintenance of certain Health Level 7 Fast Healthcare Interoperability Resources will also be required to streamline prior authorization processes and to improve the electronic exchange of healthcare data. The rule affects numerous entities, including Medicare Advantage organizations, state Medicaid, CHIP managed care entities, and other payers. Implementation of certain provisions starts as early as January 1, 2026.

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