CLV IntelligenceReimbursement Policy Monitoring

Alert detail

Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges

Policy ID: 2026-07205Specialty: Medicare AdvantageAdded: 6/2/2026Effective: April 14, 2026federal rule
Low

What changed

Final Rule published 2026-04-14. These proposals are intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the interoperability of systems used across the health care industry. We are proposing new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS

Who’s affected: Medicare Advantage billing teams · Effective: April 14, 2026

Primary source: View the official CMS/MAC document ↗

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