The National Council of Insurance Legislators (NCOIL) has adopted the Prior Authorization Reform Model Act at its 2025 Annual ...

Artificial intelligence will soon be used for prior authorization for certain Medicare services in Texas and five other ...

CMS compliance deadlines and heightened cybersecurity expectations are accelerating payer interoperability and utilization management modernization while shifting vendor selection toward platforms ...

Prior authorization — in which a patient needs approval from the health plan before proceeding with a medical service — has long created a rift between payers and providers. It has gotten such a bad ...

The CMS will soon make it more difficult for providers in six states to get reimbursed in Medicare for certain medical procedures it has deemed “low value,” but some stakeholders worry it could lead ...

A year ago, the killing of a health insurance executive on a Manhattan sidewalk unleashed many Americans’ pent-up frustration with insurers’ delays and denials of care.

Of the many tools that payers use to control costs, prior authorization ranks high on the list of what providers and patients find particularly vexing. However, Health Care Service Corporation hopes ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

St. Peter’s Healthcare System prepared its staff and processes for the new Medicare prior authorization pilot starting January ...