Navigating Recent CMS Mandates with Intelligent Technology and Smarter Utilization Management

Regulatory expectations are evolving beyond administrative compliance. CMS is increasingly focused on how UM programs function operationally across the entire care journey from intake and review to communication and documentation.

In this report, healthcare executives will gain insights into:

  • Key CMS mandates currently shaping utilization management, including requirements around faster authorization turnaround times and improved decision transparency

  • Why traditional denial-driven UM models are becoming unsustainable under increased regulatory scrutiny

  • How a 5-layer enterprise UM operating model can strengthen governance, technology alignment, compliance readiness, and executive oversight

  • The role of  intelligent automation in accelerating decisions while maintaining clinical oversight

  • Real-world examples of how collaborative UM models can reduce denials, improve provider relationships, and deliver measurable cost savings

 

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About WNS-HealthHelp

HealthHelp, a unit within WNS, is a trusted healthcare technology platform for health plans’ clinical programs for over 25 years. Our unified suite of Advanced AI powered technology platform-based solutions simplifies medical complexity and workforce challenges, and enhances provider relations and member journeys (i.e., customer experiences). Our uniquely designed UM and clinical solutions were developed to fit into health plans’ existing clinical programs to advance outcomes and success. We work in partnership to understand health plan commercial and Medicare clinical programs, and determine where our solutions can advance outcomes and lower cost. There is no one size fits all, and we know how to expediently deliver the best tailored solution for a specific health plan’s needs.

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