Last summer, the Trump administration announced a voluntary pledge by health insurers to reform prior authorization, but patient advocates and medical providers remain skeptical.

Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG). The OIG review included ...

Prior authorization has been a bone of contention between payers and providers for some time now. Payers argue that it helps avoid unnecessary care and reduces costs, while providers say it creates ...

Many private health insurers require medical providers to get approval before administering treatment, sometimes resulting in delayed or denied care for patients. Now, that tactic, known as prior ...

Use of prior authorization in the Medicare Advantage (MA) program continues to increase, according to a report from KFF. More than 46 million prior authorization requests were submitted to Medicare ...

The need to fix healthcare’s antiquated prior authorization (PA) process remains a hot-button issue in the industry, garnering policy attention and spurring the development of myriad technology ...

The push toward healthcare interoperability and electronic prior authorization is meant to ultimately benefit patients and providers. However, providers will have to navigate these changes and ...

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), ...

Don't let insurance delays stall your ulcerative colitis remission. Learn how to navigate prior authorization, step therapy, and specialty pharmacy hurdles.

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist ...

This article originally appeared on Undark. Last December, a young patient was admitted to Nationwide Children’s Hospital in Columbus, Ohio, after several medications had failed to quell the child’s ...

According to a study by the U.S. Government Accountability Office (GAO), patients face greater challenges with receiving approval for mental health services than medical services. The demand for ...