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CMS rules, OIG fraud alerts, and payor policy changes — before they affect your AR.
Umbrella network changes, Zelis/DenteMax/DNOA shifts, and what it means for DSO claim routing.
When denial rates spike, we tell you why, which payors, and what appeal strategy is actually working.
Cheat sheets, templates, and calculators for your billing team — no charge, ever.
Hey Sarah,
Three things your revenue cycle team needs to know this week:
#1: CMS just finalized prior auth requirements for Medicare Advantage
Plans must respond to urgent requests within 72 hours and standard requests within 7 days — effective 2026. What this means: your MA prior auth workflow needs a hard deadline audit before Q2.
→ Find the updated policy on Axlow in 20 seconds
#2: MetLife PDP Plus network changes are live
DSOs with Careington umbrella contracts are being repriced at PDP rates. If you haven't audited your EOBs for repricing in the last 60 days, this is the week to do it.
→ Map your claim routing on PayorMap
#3: Denial rates just hit a 5-year high
Medical necessity denials are up 18% YoY per the 2026 CAQH Index. The root cause isn't what most teams think — read our full breakdown.
This week's free resource: 2026 Prior Auth Compliance Checklist → revcycleai.com/free
— RevCycleAI Team