Prior authorization (PA) is a widely used insurance mechanism intended to ensure cost-effective, evidence-based care. However, in practice, it often imposes significant administrative and clinical ...

‘Revenue, cost and provider-patient loyalty’: Why automation is a must for prior authorization Despite a push by healthcare organizations in recent years to automate the prior authorization process, ...

Share on Facebook. Opens in a new tab or window Share on Bluesky. Opens in a new tab or window Share on X. Opens in a new tab or window Share on LinkedIn. Opens in a new tab or window ORLANDO -- The ...

CMS finalized a rule Jan. 17 aiming to streamline the prior authorization process and improve the electronic exchange of health information that it estimates will save $15 billion over 10 years. ACHP ...

An online survey identified that documentation requirements and communication issues with health plans are associated with providers modifying clinical decisions to avoid medication prior ...

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.

More than half of providers and 43% of payers have yet to start work on the application programming interface requirements of the interoperability and prior authorization final rule, according to a ...