CMS: AI, Algorithms Can’t Be Used To Deny Care, But Can Assist In Prior Auth

By Emma Beavins / February 12, 2024 at 5:57 PM
Medicare Advantage plans cannot use artificial intelligence and algorithms to deny prior authorization requests, but can use the technology to assist in coverage decisions, CMS clarified in a Feb. 5 frequently asked questions document that builds on regulations the agency laid out in its calendar year 2024 Medicare Advantage and Part D rule. The use of algorithms by insurers to make coverage and payment decisions has come under scrutiny in the last several years, including through an HHS Office of...


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