Prior Authorization Modernization

Modernization Was Never About Speed
Why CMS Reframed Prior Authorization as a Scale Problem

When CMS talks about modernizing prior authorization, it’s easy to assume the objective was faster decisions.

Speed was visible.
But speed was not the structural problem.

Scale was.

In 2024, Medicare Advantage plans processed more than 50 million prior authorization requests, continuing a steady year-over-year increase. While only a small percentage were ultimately denied, many patients still experienced delays—even when care was approved.

The issue was not simply turnaround time. It was that the underlying infrastructure was not designed to handle that volume without friction.

Prior authorization workflows built on document uploads, portal logins, manual review queues, and fax-based processes cannot scale sustainably in a Medicare Advantage environment that continues to grow.

CMS did not intervene because approvals were slow. CMS intervened because the architecture was brittle.

As request volume increases, human-intensive workflows compound administrative burden across both payers and providers. Friction scales faster than capacity.

Modernization, in CMS terms, means structural redesign. Moving from document-driven review to standardized digital infrastructure capable of absorbing rising demand without amplifying delay.

The system did not need to be faster.
It needed to be viable at scale.

Source: Healthcare Dive. Medicare Advantage prior authorization requests rise in 2024.

See What Scalable Prior Authorization Looks Like at HIMSS

If modernization was about scale, then the real question is whether your infrastructure can withstand Medicare Advantage growth without multiplying friction.

At HIMSS 2026 in Las Vegas (March 9–12), AaNeel will be demonstrating how interoperability-first prior authorization replaces document-driven workflows with standards-based digital infrastructure.

Visit us at Booth #249 in the FHIRBall Alliance Pavilion to see:

• FHIR-based prior authorization workflows
• EHR-to-plan exchange in real time
• Infrastructure designed for Medicare Advantage scale

Modernization is not theoretical.
It’s operational.

Stop by Booth #249 and see how prior authorization was redesigned for volume.

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👉 www.healthaccesscard.com