Behemoth health insurers claim this time-wasting practice improves care and saves everyone money. Look beyond the myths and find out the facts.

Legislation focused on prior authorization reforms is headed to the governor after Senate lawmakers approved changes to the ...

Legislation focused on prior authorization reforms is headed to the governor after Senate lawmakers approved changes to the ...

CMS Rule 0057 requires health plans to develop and support FHIR-based APIs to enable electronic prior authorization (ePA). Whether return on this investment stops at ...

This story also ran on CBS News. It can be republished for free. Do you have experience with prior authorization you’d like to share with us for KFF Health News’ reporting? Tell us here. Sometimes, as ...

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In addition to concerns about AI, the survey revealed concerns about delays in care, health care costs, and physician burnout. Most physicians surveyed expressed concern that health insurance ...

4x faster trend analysis to identify utilization pattern changes and outliers "Health plans want to support providers in delivering appropriate patient care and reducing abrasion," notes Cohere ...

Reauthorization is a type of prior authorization, a process used by insurers and PBMs to help determine the medical necessity of services, procedures and medications before coverage. Insurance ...

In 2023, the company eliminated 20% of prior authorization requirements and in 2024, introduced a gold card program, which allows certain providers to skip prior authorization for specific services.

If your patient's medical condition warrants the use of a quantity greater than the listed quantity for a drug, you may submit a Pharmacy Quantity Limit Exception Prior Authorization Form to request ...

Medicare Advantage, or Part C, offers Part A and B coverage and usually some form of prescription drug ... you’ll pay more for them. Prior Authorization Requirements Uncommon.