In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

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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 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 ...

The New Mexico Office of Superintendent of Insurance urges all health insurance consumers to actively monitor the status of any prior authorization requests submitted on their behalf. Prior ...

In a recent survey, 84% of providers reported the number of medical services that require prior authorization has increased. And 62% of providers reported that they do not have the technology to ...

Massachusetts regulators would eliminate many prior authorization rules, speed urgent approvals and form a working group to ...