AXIS Policy Intelligence monitors coverage policies from 200+ commercial insurers, Medicare contractors, and Medicaid plans nationwide. This feed is updated continuously — when a payer publishes or revises a medical policy, billing guideline, or prior authorization requirement, it appears here. Try filtering by payer name to find updates relevant to your health system.
HFMA Resource — March 2026
AI Can Improve Prior Authorization, But Won't Solve All Issues
Back-office inefficiency makes prior authorization more burdensome than it should be, with staff navigating fax machines, numerous payer portals, and lengthy policy documents — some running 20 to 50 pages. AI can help by first determining whether authorization is even necessary, then pulling relevant clinical information from the EHR and submitting it to the appropriate payer portal.
Source: Healthcare Financial Management Association
HFMA Resource — February 2026
Updated Documentation Requirements in Medicare Could Add Provider Burden
CMS issued a regulatory update expanding Medicare prior authorization and documentation requirements starting April 13, most meaningfully affecting DMEPOS vendors but also impacting hospitals and front-line providers. Seven new items now require prior authorization, including five codes for orthoses and two for pneumatic compression devices.
Source: Healthcare Financial Management Association
May 14, 2025 – On April 28, 2025, CMS awarded Cotiviti, LLC, the new RAC Recovery Audit Contractor (RAC) Region 3, 4, and 5 contracts. RAC Region 3 includes the following Medicare Administrative Contractor (MAC) jurisdictions: JJ, JM, and JN. RAC Region 4 includes jurisdictions: JE, JF, and JL, and RAC Region 5 includes jurisdictions: JA, JB, JC, JD, as well as the HH/H MACs: J6, J15, JK, and JM.
In RAC Regions 3 and 4, Cotiviti is the incumbent. Performant, the RAC previously responsible for reviews in RAC Region 5, remains under contract with CMS to support the RAC Program from an administrative and appeals perspective in this region, while Cotiviti will soon start active reviews.
In all the 3 newly awarded RAC Regions, CMS anticipates Cotiviti will begin reviews in the Summer (2025). RAC Region 5 providers can rely on the review completion date specified in the review results letter, as well as the RAC’s name on the letter, to identify which contractor to reach for inquiries. If Performant receives inquiries regarding reviews conducted by Cotiviti, Performant customer service will inform providers to reach out to Cotiviti and vice versa.