Navigating the CMS Prior Authorization Final Rule: What Health Plans Need to Know

In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized sweeping new rules aimed at improving the prior authorization process. These changes, set to take effect starting in 2026, will require most health plans to fundamentally rethink how they manage authorizations, interoperability, and member communication. For health plans—including Medicaid managed care organizations (MCOs),… Continue reading Navigating the CMS Prior Authorization Final Rule: What Health Plans Need to Know

The Future of Medicare Advantage: Finding the True North with AI and Innovation

The Medicare Advantage (MA) landscape is evolving rapidly, carrying significant implications for providers, payers, and beneficiaries alike. In a recent webinar titled The Future of Medicare Advantage in the Trump Transition – Will AI Help Pave the Way?, InfoMC Board Member and renowned population health expert Dr. David Nash joined fellow industry leaders from the… Continue reading The Future of Medicare Advantage: Finding the True North with AI and Innovation

Bridging the Gap: The Future of Medicare and Medicaid Integration

The healthcare landscape is transforming, and at its heart lies a crucial evolution: the integration of Medicare and Medicaid services. For millions of Americans who qualify for both programs, this integration represents more than just administrative efficiency—it’s about creating a healthcare experience that truly serves their needs. Understanding the Human Side of Dual Eligibility Meet… Continue reading Bridging the Gap: The Future of Medicare and Medicaid Integration