New PA Reporting Requirements Expose High Denial Rates

New CMS mandates require insurers to publicly disclose aggregate prior authorization denial rates, revealing denials of up to 18% in ACA Marketplaces but omitting service-line and drug-specific details. The rule aims to improve electronic PA workflows with mandated APIs by 2027, pushing real-time automation tools in EHRs to reduce administrative delays.

This Wire brief sits within Fusion42's coverage of Healthtech Infrastructure.