Ohio is one of six states testing an AI-led prior authorization program for around a dozen medical procedures for patients ...

How smarter, EMR-integrated ePA eliminates noise, speeds resolution, and sets the stage for touchless prior authorization.

KFF Health News. When Sally Nix found out that her health insurance company wouldn't pay for an expensive, doctor-recommended treatment to ease her neurological pain, she prepared for battle. Denials ...

Prior authorization has been a bone of contention between payers and providers for some time now. Payers argue that it helps avoid unnecessary care and reduces costs, while providers say it creates ...

The COVID-19 pandemic is changing the way healthcare does business – sometimes in temporary ways, sometimes in ways that may suggest permanent change when the crisis has passed. Prior authorizations ...

I speak with infusion leaders every day—from major health systems to independent infusion practices—and the same challenge comes up time and again: ...

Prior authorization of drugs, diagnostic testing, or other medical services “is intended to ensure that health care services are medically necessary by requiring providers to obtain approval before a ...

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist ...

The letter from Sen. Richard Blumenthal comes one year after a Senate investigation criticized major MA payers for using predictive technology to deny post-acute care.

The Centers for Medicare & Medicaid Services' (CMS) has recently demonstrated a focus on promoting patient care by removing unnecessary obstacles to prior authorization. Prior authorization is a payer ...

GI docs say the payer is using AI to move large volumes of services through prior authorization. Effective June 1, UnitedHealthcare will require prior authorization for nearly half (47%) of ...

A report by the Office of Inspector General (OIG) finds Medicaid managed care members may not be receiving all medically necessary services. Medicaid managed care organizations (MCOs) denied one out ...