State insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements for “many ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

The American Hospital Association has sent a letter to the Centers for Medicare and Medicaid Services requesting that the latter revise proposed regulations regarding prior authorizations, citing ...

The Wasteful and Inappropriate Service Reduction Model, or WISeR, is being tested in six states, including Oklahoma, starting ...

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 ...