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By EMANUEL SARKEES Most people have never heard of prior authorization until it personally stops them from getting care they actually need. The way it usually goes is pretty straig...
FORT LAUDERDALE, Fla. — Appealing claims denials in the prior authorization process requires continuous pressure, according to a presenter at the 2026 Rheumatology Nurses Society a...
UnitedHealthcare, Network Health and Aetna are among the first group of health plans to go live with the API, while Ochsner Health, Froedtert ThedaCare Health, Denver Health and Su...
UnitedHealthcare said earlier this year that it was aiming to eliminate 30% of prior authorization requirements by the end of 2026.
Few things are more frustrating than standing at the pharmacy counter, ready to pick up a vital medication, only to be told it isn’t covered...
KFF found that insurers denied 12%-18% of standard prior authorization requests in 2025, with significant variation among insurers and gaps in transparency. The post KFF: Insurers...
Researchers analyzed data from insurers in Medicare Advantage, Medicaid managed care and ACA Marketplace segments—representing approximately 71 million enrollees.
The House Ways and Means Committee unanimously advanced a bill to reform Medicare Advantage prior authorization requirements. The post Healthcare Groups Praise Unanimous Committee...
Statement attributable to: - Willie Underwood, MD, MSc, MPH - President, American Medical Association - - “Quick-moving legislation to reform prior authorization—adopted tod...
The letter says denied. It’s not the first one this month, and the physician already knows how this goes: Read it, feel briefly annoyed, and move on to the next patient, because th...
When staff are overextended and patients face delays or abandon care, the issue is no longer a narrow administrative burden. It becomes a business, financial, and access challenge...
CMS has updated its guidance on prior authorization metrics reporting, addressing the AMA’s concerns about how health insurers were disclosing requirements and outcomes, according...
The companies say providers will receive quicker, first-time approvals through the partnership, ultimately giving members quicker care access.
Last year, the Trump administration announced a voluntary pledge by dozens of insurers to improve prior authorization, which often requires patients to seek approval before treatme...
Humata’s AI-powered solution has allowed physicians to achieve a 96% first-pass approval rate while reducing write-offs by 30%, executives say.
Wael Khouli wrote here on July 26 that AI will not replace physician advisors, volume will. He is right, and his argument applies elsewhere in the clinic to the people who build pr...
The American Medical Association (AMA) welcomed updated guidance from the Centers for Medicare & Medicaid Services (CMS) that strengthens enforcement of federal prior authori...
The organization said the agency responded to its concerns about payers' implementation of the transparency provisions of the 2024 final rule.
Hospitals and other medical providers are increasingly asking for payment before providing care, collecting more of what patients might owe as rising insurance deductibles add to A...
A new interoperability initiative will begin by targeting prior authorization cases that have the “greatest potential” to reduce administrative burden and aid patients in receiving...
Thomas Zordani flew from his home in Denver to Phoenix for a consultation with a Mayo Clinic neurosurgeon, hoping to find out what could be done to treat his debilitating headaches...
The government is piloting a program that uses AI for insurance-coverage decisions.
Every clinician can attest to the annoyance, stress, and worry that manifests when we think about paperwork. Even the likes of a snake oil salesman currently in charge of CMS, Dr....
Do doctors have to petition insurers to get some care approved?
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