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

Few healthcare processes feel more entrenched than prior authorization — the insurer approval protocol that’s become shorthand for delays and red tape that complicates care and goodwill between ...

As the year comes to a close, the Trump administration seems to be going in two different directions when it comes to the use of prior authorization in Medicare. On the one hand, there is the effort ...

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 ...

More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or ...

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets a new standard for how payers exchange data and respond to authorization ...

Medicare Advantage plans required prior authorizations about 125 times more often than regular Medicare in 2023, demonstrating the barriers MA patients face in accessing care. An analysis published by ...

Three new studies highlighted the growing burden of prior authorization on both oncologists and patients. Findings from a survey of radiation oncologists, for instance, revealed that more than 80% ...

Zack Sigel is a writer and editor based in New York City. He has been managing editor at Policygenius and M1 Finance, where he led teams specialized in writing about business and finance, and he has ...

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 ...