A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

Few healthcare processes feel more entrenched than prior authorization — the insurer approval protocol that’s become shorthand for delays and red tape that complicates care and goodwill between ...

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 ...

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets a new standard for how payers exchange data and respond to authorization ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

In 2025 alone, doctors and legislators across the country have already introduced more than 100 pieces of legislation meant to reform prior authorization. The cumbersome approval process is a leading ...

Three new studies highlighted the growing burden of prior authorization on both oncologists and patients. Findings from a survey of radiation oncologists, for instance, revealed that more than 80% ...

As the year comes to a close, the Trump administration seems to be going in two different directions when it comes to the use of prior authorization in Medicare. On the one hand, there is the effort ...

Zack Sigel is a writer and editor based in New York City. He has been managing editor at Policygenius and M1 Finance, where he led teams specialized in writing about business and finance, and he has ...

HENRICO, Va. — Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her ...