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 ...

Strengthen your financial backup. Even with Medicare coverage, unexpected out-of-pocket expenses can pop up. Earn as much as ...

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

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 ...

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 ...

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 ...

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 ...

UnitedHealthcare, facing a storm of backlash from docs over its decision to implement a policy that would require prior authorization for some surveillance and diagnostic colonoscopies, is pushing ...