A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

Medicare is launching a new pilot program that will require prior approval for 17 health services using artificial ...

While the AHA has called on CMS to rethink its plan to add prior authorization requirements to traditional Medicare, some argue that the program is due for some utilization management. CMS has sparked ...

Health insurance companies are expected to hold to their promises in 2026 to “streamline, simplify and reduce” prior ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

Initially meant to protect patients from unnecessary procedures, prior authorizations have shifted towards being a cost containment strategy for health payers. This shift is causing significant ...

Payer updates and policy changes delay reimbursement; Leaders say automated solutions can help fight back. The tug-of-war between providers and payers over prior authorizations is a consistent and ...

There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

Physicians groups on January 17 hailed a new federal rule requiring health insurers to streamline and disclose more information about their prior authorization processes, saying it will improve ...

As tens of millions of Americans struggle with gastrointestinal diseases such as colorectal cancer and ulcerative colitis, health insurance company UnitedHealthcare (UHC) is making life more ...