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 ...
CMS has proposed extending its prior authorization interoperability framework to cover drugs for the first time, building on its 2024 rule that focused on medical items and services. The proposed rule ...
The Trump administration has issued a proposed rule that aims to significantly overhaul prior authorization for ...
For decades, Americans have endured a healthcare system where access to care is delayed not by clinical need, but by administrative demands with little benefit. Prior authorization, the process ...
The Centers for Medicare & Medicaid Services April 10 released a proposed rule that would establish electronic standards for ...
Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid Services (CMS) trials its much-discussed “Wasteful and Inappropriate Service ...
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 ...
Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. On June 27, 2025, the Centers for Medicare and Medicaid ...
Major insurers have cut 11% of prior authorizations after committing to roll back the controversial processes last year, according to major trade groups. The reduction equates to 6.5 million fewer ...
June 23 (UPI) --Major American insurers announced Monday that they have agreed to speed up and smooth out the processes involved with the reception and administration of health care by streamlining ...
The fifth annual Abarca Forward conference, hosted by the pharmacy benefit manager (PBM) Abarca Health at its headquarters in ...
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Should doctors charge patients for prior authorization?
Between one-off charges, administrative fees, and office visit copays, some are trying ...
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