Lawmakers on Thursday explored the merits of a bill that would block the Centers for Medicare & Medicaid Services (CMS) from ...

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

Strengthen your financial backup. Even with Medicare coverage, unexpected out-of-pocket expenses can pop up. Earn as much as ...

Health insurance companies are expected to hold to their promises in 2026 to “streamline, simplify and reduce” prior ...

While the AHA has called on CMS to rethink its plan to add prior authorization requirements to traditional Medicare, some argue that the program is due for some utilization management. CMS has sparked ...

Initially meant to protect patients from unnecessary procedures, prior authorizations have shifted towards being a cost containment strategy for health payers. This shift is causing significant ...

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 ...

UnitedHealthcare, facing a storm of backlash from docs over its decision to implement a policy that would require prior authorization for some surveillance and diagnostic colonoscopies, is pushing ...

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 ...

Physicians groups on January 17 hailed a new federal rule requiring health insurers to streamline and disclose more information about their prior authorization processes, saying it will improve ...