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 ...
Prior authorization has long been a source of friction for providers and patients alike. In this interview, Dr. Michelle Gourdine, Chief Medical Officer at CVS Caremark, explains how the organization ...
California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve or deny medical treatments. When Ocean McIntyre started having vision ...
Insurer is eliminating prior auth for many diagnostic procedures, routine surgeries, and cardiology, neurology, pulmonology and orthopedic specialty care.
The Centers for Medicare and Medicaid Services (CMS) is poised to launch a bold, new initiative to reduce waste, fraud and abuse. Starting January 1, 2026, the Wasteful and Inappropriate Service ...
Elisa Auguste, administrator at East Setauket, N.Y.-based Precision Care Surgery Center and vice president of the New York State Association of ASCs, joined Becker’s to discuss how deeper ...
Imagine you and your gastroenterologist have discussed a new ulcerative colitis (UC) treatment plan that promises to reduce your symptoms and the stress that comes with them. Then, when you go to ...
Prior authorization today is a far cry from its limited origins, when private insurers used it to scrutinize the necessity of hospital admissions. But what began in the 1960s as a relatively modest ...
Supporters say a bill working its way through the Iowa Senate could speed up the process insurance companies and government-run insurance programs require before approving a patient’s medical ...
AI-driven prior authorizations (PAs) are trusted by many clinicians, promising to streamline processes and reduce administrative burdens. Concerns exist about AI increasing denial rates and lacking ...
UnitedHealthcare said on Tuesday it is eliminating "prior authorization" requirements for 30% of medical services that previously required insurer approval, a policy shift that could eliminate red ...
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