Drugs were left out of a 2024 rule streamlining prior authorizations, including by making decisions electronic and requiring ...

US health insurers are advancing toward real-time prior authorization decisions by 2027 after reducing request volumes by 11%, eliminating 6.5 million transactions in 10 months. Insurers are working ...

But making sense of the numbers isn't easy, experts say ...

Payers prior authorization denial rates must be publicly reported starting March 31, 2026, improving transparency for Medicare Advantage and ...

Urgent requests would require an answer in 24 hours, and standard requests in 72 hours ...

Prior authorization forces doctors to spend 13 hours a week fighting insurers. New federal rules are changing that—here's what you need to know.

A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public ...

Close to 60% of providers who responded to an HFMA survey say they have yet to implement AI or automation in the revenue ...

It’s a lucrative shakedown if you can get it, and insurers have been getting it since the passage of the 1973 Health ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

When Sally Nix found out that her health insurance company wouldn’t pay for an expensive, doctor-recommended treatment to ease her neurological pain, she prepared for battle. It took years, a chain of ...

The impact of using AI to evaluate these prior authorizations is unclear. AI could allow tech companies to automatically approve more cases, which could speed up decisions. However, companies could ...