A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

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 ...

More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or ...

Remember that physician who wanted to develop a Current Procedural Terminology (CPT) code for prior authorizations? It hasn't happened yet, but he hasn't given up on it, either. In May, Alex ...

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 ...

In a future state, the automation of prior authorization decisions would be a natural element of high quality, value-based care. After all, the goal of prior authorization is to ensure that a member’s ...

The Trump administration has promised to reduce the burden of prior authorizations, but experts say there is no easy solution. Prior authorizations, where insurers must approve certain medical ...

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets a new standard for how payers exchange data and respond to authorization ...

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. My 90-year-old uncle, a retired county employee, has had a ...

Few healthcare processes feel more entrenched than prior authorization — the insurer approval protocol that’s become shorthand for delays and red tape that complicates care and goodwill between ...

Humata Health has received $25 million in a funding round to improve the prior authorization experience for payers and providers. The funding round was led by Blue Venture Fund, the VC arm of most ...