Blaming prior authorization for “eroding trust between payers and providers,” federal officials said Monday they are evaluating how prior approvals might be better targeted to improve healthcare ...

One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now. Alex Shteynshlyuger, M.D., ...

CMS recently announced a new model it will be using to pilot the use of artificial intelligence and machine learning in reviewing prior authorizations submitted for certain services CMS has identified ...

In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

The CMS will soon make it more difficult for providers in six states to get reimbursed in Medicare for certain medical procedures it has deemed “low value,” but some stakeholders worry it could lead ...

This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. The CMS will test a new model beginning next year ...

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.

Innovative new submission improvement -- available 24 hours a day, seven days a week -- provides nearly instant responses in most cases IRVINE, Calif.--(BUSINESS WIRE)-- Prescription Solutions, a ...

Cigna Healthcare, the health benefits provider of the Cigna Group, will be removing close to 25% of medical services from prior authorization requirements, the insurer said today. With the removal of ...

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