By Elizabeth Geigle, MHA, CPHQ, CHC, Health Insurance Regulatory Specialist
For Medicaid health plans, the CMS-0057-F rule's 72-hour expedited prior authorization standard is more than a compliance checkbox. It comes with hidden costs and operational hurdles that can strain resources, complicate workflows, and affect member outcomes all at once. The prior authorization process exists within a complex ecosystem of schedules, documentation requirements, and coordination points that, when misaligned, create ripple effects across the entire care delivery chain. This article breaks down what's really driving those inefficiencies and, more importantly, how health plans can design their operations to meet Medicaid compliance while building a system that works better for both the plan and the members it serves.
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