Prior authorization

CMS-0057-F Prior Authorization Rule: No Verification Behind the Numbers

CMS-0057-F requires payers to publicly post prior authorization metrics — but CMS's own rule text confirms no independent audit or certification process backs the disclosure. The insurance industry's voluntary pledge has the identical gap.

Prior authorization accountability gap: complete teal wireframe column beside an unresolved grey structure on deep navy.

Healthcare compliance

H.R. 9396 Prior Authorization Accountability Act: Disclosure Without Accuracy Verification

H.R. 9396 would require health plans to publish PA denial rates, appeal outcomes, and AI decision metrics starting 2027 — but contains no attestation, audit, or accuracy framework. Here's what compliance teams need to watch before rulemaking closes.

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