Navigating the CMS Prior Authorization Mandate with MCG
In this webinar, we delve into the nuances of the 2024 CMS Interoperability and Prior Authorization Rule (CMS-0057-F) and its impact on the healthcare ecosystem. Drawing on their expertise from being among the nation's first implementers of the new standard, speakers from MCG Health will discuss the details of the prior authorization API mandate, offering guidance for impacted payers, providers, and their patients.
This session will cover the technical details, operational shifts, and the mandate's far-reaching impact on healthcare efficiency, transparency, and patient outcomes. As pioneers in the field, MCG has firsthand experience in reducing administrative burdens and improving care delivery, providing a roadmap for payers and providers navigating these regulatory changes. Their insights and experiences are invaluable in understanding the mandate's practical aspects, potential challenges, and strategies for effective implementation.
Learning Objectives:
- Analyze the impact of the Final Rule on healthcare providers and payers
- Assess the technical foundations and implementation challenges of the Final Rule for impacted healthcare providers and payers
- Evaluate the steps your organization should consider in preparation for the mandate
Speakers:
Rajesh (Raj) Godavarthi
Associate Vice President of Technology and Interoperability
MCG Health
Rajesh “Raj” Godavarthi is MCG Health’s Associate Vice President of Technology and Interoperability. Mr. Godavarthi has been with MCG since 2002, and he oversees a team of software developers and architects that are building the key interoperability solutions that are outlined in MCG’s roadmap for the future. His team also helps develop, enhance, and maintain MCG’s evidence-based clinical decision support software currently used by nine of the largest U.S. health plans and nearly 2,600 hospitals.
In addition, Mr. Godavarthi is MCG’s primary representative in the HL7 Da Vinci Project. MCG has been an Associate Member of this consortium since 2019, and Mr. Godavarthi has led our efforts to support industry stakeholders developing new HL7® FHIR® standards which will allow for improved interoperability and communication between payers and providers. In September 2021, Mr. Godavarthi was named the co-lead for the HL7® Da Vinci Project’s burden reduction use cases in prior auth support (PAS), coverage requirement discovery (CRD), and documentation templates and rules (DTR). In May 2022, he was recognized as one of the 2021 Da Vinci Community Champions. These individuals are publicly acknowledged for making significant contributions to advancing implementation guide use.
In July 2021, he became a member of the WEDI Prior Authorization Subworkgroup. WEDI (Workgroup for Electronic Data Interchange) is a formal advisor to the U.S. Secretary of Health and Human Services (HHS). They are a leading authority on the use of health IT to efficiently improve health information exchange, enhance care quality, and reduce costs.
In December 2021, Mr. Godavarthi was elected to the WEDI Board of Directors, and he was subsequently appointed to serve a 3-year term on the Office of the National Coordinator for Health Information Technology (ONC)’s Health Information Technology Advisory Committee (HITAC).
In July 2022, Mr. Godavarthi was recognized by the HL7® Da Vinci Project as one of eight healthcare technology experts who are 2021 Da Vinci Community Champions.
Daniel Cawood
Senior Manager, Product Management
MCG Health
Daniel Cawood oversees the product development for MCG Health’s interoperability solutions as well as connecting payers and providers for authorization processes. Mr. Cawood began his time at MCG with a focus on the Indicia suite of solutions (provider market clinical decision support) and value-based care solutions. Before joining MCG, he was a Product Owner for Research & Development solutions at Optum Technology. At Optum, he focused on using advanced technologies to solve operational, clinical, and business problems ranging from chronic care management to benefit administration and beyond. Prior to Optum, Daniel was a Business Architect at UnitedHealthcare working on provider network operations. He graduated with a degree in Management Information Systems from the University of Minnesota – Twin Cities.