Medicaid Prior Authorization Data Is Now Visible to CMS
PCOOB Weekly July 30, 2026 | Vol. 2, Issue 27 When CMS Can See Every Denial The June 2026 MCPAR
The Directory Is Wrong. Twice.
PCOOB Weekly • June 23, 2026 • Regulatory Analysis The Directory Is Wrong. Twice. Medicaid managed care plans submit network
Elevance Health data certification non-compliance: Seven Years of Knowing. One Month to Fix It.
July 16, 2026 · Risk Adjustment / Program Integrity / Data Governance Elevance Health data certification non-compliance: Seven Years of
Reconciliation Law Rewires How Medicaid Plans Get Paid
Three simultaneous financing shocks, provider tax compression, state directed payment caps, and enrollment acuity shift, are now law for Medicaid managed care.
The Measure Is Gone. The Risk Isn’t.
Removing a measure from the Stars scorecard does not remove it from the compliance framework, the audit universe, or the enforcement landscape. Plans that read CMS’s voluntary 2027 recalculation,
D-SNP Compliance Now Runs on Two Regulatory Calendars
PCOOB Weekly — June 25, 2026 D-SNP / Duals / MA Compliance D-SNP Compliance Now Runs on Two Regulatory Calendars
Medicaid managed care provider payments restructuring
PCOOB Weekly — June 18, 2026 PCOOB Weekly | June 18, 2026 | Regulatory Analysis Medicaid managed care provider payments
The MCO Is Not in the Room. It Still Has to Pay the Bill.
The 2025 federal budget reconciliation law’s Medicaid work requirements hand states the policy design while managed care organizations absorb the financial exposure.
Ten Days to Comment: What the CMS-0062-P Drug PA Interoperability Rule Requires
PCOOB Weekly — June 5, 2026 10 PCOOB Weekly · June 5, 2026 · Prior Authorization / Interoperability / IT
The Guardrails Came Down. The Enforcement Didn’t.
PCOOB Weekly — May 29, 2026 PCOOB Weekly · May 29, 2026 · MA Marketing / FDR Oversight / OIG
The 80% Number Isn’t a Customer Service Problem. It’s a Compliance Finding.
PCOOB Weekly — May 22, 2026 80% PCOOB Weekly · May 22, 2026 · Appeals & Grievances The 80% Number
CMS Redesigns Program Audits. Your Audit Readiness Program is Still Built for Scoring
PCOOB Weekly — May 15, 2026 PCOOB Weekly — Issue 5 — May 15, 2026 The Audit Changed. Your Audit