Prior authorization has emerged as a flash point between payers and providers as the former tries to manage what they believe is waste in the system while the latter accuses payers of trying to deny ...

There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

Recently two members of our family had to obtain prior authorization from their health insurance. One person wanted a knee replacement by an orthopedic surgeon and his request was approved; the other ...

When the doctor says you need a prescription or treatment, sometimes you need approval from your health insurance first.

The intelligent automation will deliver more timely decisions that reduce delays and improve access to care, Optum says.

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization ...

One increasingly subtle but important theme in US healthcare is the shift to care allocated by payers rather than providers. Historically, decisions on what care to provide patients were made by ...

While there's a lot of buzz around prior authorization, it applies to fewer than 2% of claims. Prior authorization ensures care is both safe and aligned with the most up-to-date clinical guidelines.

While major provider organizations welcomed insurers' pledge earlier this week to reform prior authorization, these groups withheld praise without yet seeing the efforts bear fruit. Bobby Mukkamala, M ...

The Medical Group Management Association said that as the number of Medicare Advantage beneficiaries continues to grow, “it is imperative that the MA program ensures adequate and transparent coverage ...