Aligning electronic data submission requirements for prior authorizations is one prong of the insurance industry’s commitment ...

Andrew Mellin, M.D., discusses Surescripts’ pilot program for prior authorization system, which pulls clinical data from EHRs ...

Participating payers reported an 11% reduction in prior authorization requirements overall, with Medicare Advantage exceeding ...

Wash., found procedures in the state that were previously approved in two weeks now take four to eight weeks to be authorized ...

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 ...

Each prior auth transaction costs practices between $20 and $30 ...

Natalie Tate, PharmD, is vice president of pharmacy at BlueCross BlueShield of Tennessee. Nationwide, prescription drugs are the costliest and commonly used heath plan benefit. Last year, BlueCross ...

Prior authorization companies are moving into ambient listening, while ambient listening companies are expanding into prior authorization — a trend underscored by yet another partnership bridging the ...

Almost 80% of physicians surveyed by the AMA say patients are skipping care because of delays in prior authorizations. Prior authorizations are a consistent pain point in revenue cycle operations, and ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

Prior authorization is a process that involves contacting a person’s Medicare provider to request coverage for a medical service, drug, or piece of equipment. If a person has Original Medicare (parts ...

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 ...