Prior authorization can feel like a roadblock, but understanding the process and setting up efficient workflows can make it far less stressful. From confirming eligibility to submitting complete ...

The approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries ...

Prior authorization is the process by which your doctor must request approval from your Medicare plan before they can order a particular medication or medical service. Generally, Original Medicare ...

Andrew Mellin, M.D., discusses Surescripts’ pilot program for prior authorization system, which pulls clinical data from EHRs ...

A smart API broker and data integration engine. Plans must query multiple systems to determine whether prior authorization is required, from member eligibility to policy coverage to provider status.

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Prior authorization — the insurer’s green light for certain treatments or medications — is about to get faster, more transparent, and more digital. Starting in 2026, new CMS rules will require ...

Forty-eight insurers, including major players, pledged to reform prior authorization processes to improve patient care access. The initiative includes technology standardization, reducing PA ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

Insurers are working to standardize how they vet requests for medical treatments and services, the latest in a series of commitments from the industry to pare back paperwork and make it easier for ...