Prior authorization forces doctors to spend 13 hours a week fighting insurers. New federal rules are changing that. Here's ...

A look at the rise of prior authorization certified specialists (PACS)—and their value in improving patient access and outcomes. The healthcare industry constantly grapples with the challenge of ...

Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of providers. Now, AHIP and the Blue Cross Blue Shield Association are providing an update on ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

The Centers for Medicare & Medicaid Services has proposed expanding its electronic prior authorization interoperability framework to include drugs, building on earlier rules for medical items and ...

For the first time, more Medicare enrollees received their Medicare benefits through a Medicare Advantage (MA) plan last year than through Traditional Medicare. We saw first-hand at the Center for ...

People walk inside a Medicare Services office in New York City. Reporter Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid ...

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 ...

An insurance company often requires this type of preapproval for certain services, procedures, prescription medications, and medical supplies. Your healthcare team can often help you navigate this ...

A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public ...

The Trump administration wants to create deadlines for federally regulated insurers to respond to prior authorization requests for drugs, along with stricter transparency requirements. On Friday, the ...