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Agentic Healthcare by Case Health AI

CMS-0057-F and Medicare Advantage Prior Authorization

07 May 2025

Description

๐Ÿ“Œ Overview:In this episode, we break down the new CMS-0057-F Final Rule and what it means for Medicare Advantage plans. From faster prior authorization decisions to mandatory FHIR-based APIs, we cover the biggest changes, the 2026โ€“2027 compliance deadlines, and the operational and technical steps plans need to take. Whether you're on the product, compliance, or engineering team, this is your guide to understanding whatโ€™s comingโ€”and how to stay ahead of it.๐Ÿ” Topics Covered:What CMS-0057-F is and why it mattersNew turnaround times for prior auth requestsRequired API implementations and data standardsReporting obligations and transparency rulesPractical steps payors can take to get ready๐ŸŽง Who Should Listen:Healthcare execs, payor compliance teams, product managers, and healthtech developers supporting MA organizations.

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