Artificial intelligence will soon be used for prior authorization for certain Medicare services in Texas and five other ...

The National Council of Insurance Legislators (NCOIL) has adopted the Prior Authorization Reform Model Act at its 2025 Annual ...

Next year, Texas will be one of six states participating in a Medicare pilot program that uses artificial intelligence to ...

CMS compliance deadlines and heightened cybersecurity expectations are accelerating payer interoperability and utilization management modernization while shifting vendor selection toward platforms ...

St. Peter’s Healthcare System prepared its staff and processes for the new Medicare prior authorization pilot starting January ...

Prior authorizations are required by insurance companies for some medications. This includes those that may have less expensive alternatives. The prior authorization process can take anywhere from a ...

The idea behind it seems reasonable: Insurers want to ensure treatments are medically necessary before they pay for them. But ...

A year ago, the killing of a health insurance executive on a Manhattan sidewalk unleashed many Americans’ pent-up frustration with insurers’ delays and denials of care.

Electronic health record providers are starting work that could transform how nursing homes grapple with prior authorization requests and length of stay determinations.

The prior authorization bundles are for condition-specific procedures, Aetna said. Previously, providers had to submit two ...

Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your ...