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 ...

The need to fix healthcare’s antiquated prior authorization (PA) process remains a hot-button issue in the industry, garnering policy attention and spurring the development of myriad technology ...

Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG). The OIG review included ...

Almost 80% of physicians surveyed by the AMA say patients are skipping care because of delays in prior authorizations. Prior authorizations are a consistent pain point in revenue cycle operations, and ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

Forbes contributors publish independent expert analyses and insights. Bruce Japsen writes about healthcare business and policy. This article is more than 2 years old. The American Medical Association, ...

Payers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management. Like many others, I was drawn to be a doctor because I ...

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist ...

Please provide your email address to receive an email when new articles are posted on . Most medications in allergy and asthma care require prior authorization. Providers should screen for failed ...

Please provide your email address to receive an email when new articles are posted on . Physicians reported that prior authorizations diverted time, increased health care utilization and delayed care.