Massachusetts insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements ...

Medicare Advantage prior authorization (PA) is the process you go through to get certain services and drugs approved before you receive them. The process can be frustrating, as it can take up to 14 ...

A new AI tool is being tested in Oklahoma to process prior authorizations in Medicare. These Oklahomans say they're worried.

The requirements will make exchanging health data more efficient and reduce administrative burden. Today CMS finalized the Interoperability and Prior Authorization Final Rule, continuing its efforts ...

Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your ...

New analysis further supports the need for stronger policies to streamline the administrative process. More than two million prior authorization requests, accounting for six percent of the 35 million ...

The Biden administration released a proposal which, if finalized, would mandate Medicare Advantage (MA), Medicaid managed care, Affordable Care Act (ACA) plans and state Medicaid agencies implement ...

Prior authorization has emerged as a flash point between payers and providers as the former tries to manage what they believe is waste in the system while the latter accuses payers of trying to deny ...

A major pain point for physicians is also one—sometimes literally—for patients. In Texas, 25% of patients say insurers have refused to cover a medicine, procedure, test or scan that a doctor ordered ...

It's no secret that burnout is a struggle across the healthcare industry, and the complex, time-consuming prior authorization process is one contributor. In fact, the U.S. Surgeon General addressed ...

Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or ...