Sunday, March 22, 2026

CMS declined to enforce rules requiring MA plans to report prior authorization approval/denial metrics at the service level. Plans now report only aggregate data at the contract level — hiding which specific services get denied most. CMS also shelved proposed AI oversight requirements and health equity analysis of PA decisions. The rules that survived: MA plans must publish a list of items/services requiring PA and eight aggregate metrics by March 31, 2026. MA plans overturn 80% of claim denials on appeal, per CMS's own data.

Translucent closed a $27M Series A led by Google Ventures, just months after a $7M seed. Total raised: $34M. The platform connects clinical, operational, and financial data into a unified layer and uses agentic AI to automate analysis that finance teams did manually. Clients include Northwestern Medicine and Springfield Clinic. Positioned as "healthcare's financial operating system."

Availity — the largest multi-payer health information network — partnered with Abridge (the AI clinical documentation company) to build an AI-powered prior authorization experience embedded in the clearinghouse workflow. This follows Availity's August 2025 partnership with Onyx for CMS-0057 compliance. Availity also launched a Rapid Recovery cybersecurity standard post-TriZetto breach.

66.5% of U.S. bankruptcies involve medical expenses. 530,000 families file each year. Having insurance doesn't protect: 56% of insured Americans carry medical debt. The 2026 average marketplace deductible is $5,304 for silver plans, $7,186 for bronze. One in four insured Americans had claims denied, per KFF — and fewer than 1% of denied claims are appealed, though 44% of appeals succeed.

Half of the 3 million Americans brought to ERs by ambulance each year get a surprise bill. Ground ambulances were excluded from the 2022 No Surprises Act. One documented case: a $6,800 out-of-network ambulance bill that took nearly two years to fight. New Hampshire banned surprise ground ambulance billing effective January 1, 2026. Alabama has legislation moving through its Senate. Only 21 states have independent protections.