CINCINNATI, Sept. 04, 2024 (GLOBE NEWSWIRE) -- AssureCare, a leader in population health management, is proud to announce that its flagship product, MedCompass, is now fully compliant with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule (CMS-0057-F). This significant achievement places AssureCare at the forefront of helping payors meet the new regulatory requirements, particularly the implementation of the Prior Authorization API, allowing submission of Prior Auth Requests directly from the EHRs; this allows providers to submit accurate information, in real-time, and reduces time and effort required for payers to approve such requests.
The CMS final rule mandates that impacted payors, including Medicare Advantage Organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plans (QHP) issuers on Federally Facilitated Exchanges (FFEs), must implement and maintain certain Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) APIs by January 2027. Among these requirements, the Prior Authorization API is a crucial component designed to improve the electronic exchange of healthcare data and streamline the prior authorization process.
AssureCare’s MedCompass, a CMS-certified platform, can seamlessly receive prior authorization requests via the FHIR-based API. This functionality not only aligns with the new CMS regulations but also empowers payors to significantly reduce turnaround times and minimize the administrative burdens traditionally associated with prior authorization.
“This rule introduces substantial challenges for payors, as the Prior-Authorization Decision Timeframes for expedited and standard requests have been drastically reduced. The Turnaround Time (TAT) has been halved for standard requests from 14 days to just 7 days. This demands that payors either double their operational capacity or adopt advanced technology to accommodate these changes without inflating their cost structure. Recognizing the significant impact this could have on our clients and the industry at large, we proactively invested in making our system compliant ahead of schedule to ensure a smooth transition and help payors mitigate potential cost increases,” said Dr. Yousuf Ahmad, President and CEO of AssureCare.
About AssureCare®
AssureCare provides cutting-edge population health management software for healthcare and human services organizations like payors, providers, and pharmacies. Our enterprise solutions automate complex tasks, optimize workflows, and offer deep analytics, enabling informed decisions and cost-effective care delivery. We specialize in software solutions for risk-bearing entities, improving patient outcomes, and reducing avoidable costs. Our flagship platform, MedCompass, supports end-to-end care management trusted by leading commercial and government payors serving millions. Additionally, AssureRx optimizes patient care by managing medication-related risks for pharmacies, providers, and payors, with Pharmacist Credentialing and Medication Therapy Management capabilities. For more information, visit AssureCare.com.
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