An insurance company often requires this type of preapproval for certain services, procedures, prescription medications, and medical supplies. Your healthcare team can often help you navigate this ...

As congressional Democrats and Republicans battle over how to avert a potential government shutdown, another issue -- reining in prior authorizations -- remains on both parties' radar screens, ...

While there's a lot of buzz around prior authorization, it applies to fewer than 2% of claims. Prior authorization ensures care is both safe and aligned with the most up-to-date clinical guidelines.

The idea behind it seems reasonable: Insurers want to ensure treatments are medically necessary before they pay for them. But ...

The Centers for Medicare and Medicaid Services has announced a prior authorization program pilot for original Medicare. The six-year voluntary Wasteful and Inappropriate Service Reduction Model (WISeR ...

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences. Many states have adopted or are ...

Large health insurance companies vowed to cut down the use of and improve a common tool to vet requests before letting doctors bill for medical services or prescriptions. UnitedHealthcare, Blue Cross ...

Health insurance companies across the country have agreed to streamline and simplify the prior authorization process for patients seeking certain medical treatment, according to a nationwide industry ...

Ahead of HIMSS26, Sairohith Thummarakoti of Texas A&M University–Kingsville previews his talk on how agentic AI and low-code ...

A CMS pilot program that would add prior authorization for some traditional fee-for-service Medicare services has come under increased scrutiny by some members of Congress, including a call to pause ...

Democrats are raising concerns about a new CMS pilot program testing prior authorization requirements, which make patients get their health plan’s approval before receiving certain services, in ...

Remember that physician who wanted to develop a Current Procedural Terminology (CPT) code for prior authorizations? It hasn't happened yet, but he hasn't given up on it, either. In May, Alex ...