One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now. Alex Shteynshlyuger, M.D., ...

There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

Recently two members of our family had to obtain prior authorization from their health insurance. One person wanted a knee replacement by an orthopedic surgeon and his request was approved; the other ...

Whether you're filling a prescription or scheduling a procedure, chances are you've been asked whether you have prior authorization. By learning to navigate prior authorization and what steps to ...

Payer updates and policy changes delay reimbursement; Leaders say automated solutions can help fight back. The tug-of-war between providers and payers over prior authorizations is a consistent and ...

One increasingly subtle but important theme in US healthcare is the shift to care allocated by payers rather than providers. Historically, decisions on what care to provide patients were made by ...

Where healthcare leaders stand on CMS API rule progress shows payers advancing while many providers lag behind the Jan. 1, 2027 deadline.

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization ...

Why do I need a prior authorization for something that I am already prior-authorized to take? If my doctor says that they want me on a medication, why does my insurance have another say in that?” — ...

Prior authorization — the process by which insurers review and approve or deny treatments prescribed by doctors — has become “the only piece of healthcare that every single stakeholder, including ...

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 ...