When Sally Nix found out that her health insurance company wouldn’t pay for an expensive, doctor-recommended treatment to ...

Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG). The OIG review included ...

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 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 ...

The new CMS regulations on prior authorization have been heralded as a big step forward in reducing administrative burdens on physicians, but some people think it doesn't go far enough. The CMS ...

Prior authorization is a commonly-cited pain point for physicians, leading to potentially lengthy delays in care as docs await insurers' OK to proceed with treatment. That's why Portland-based health ...

Objective: To evaluate the effectiveness of an automated prior authorization (PA) system (SmartPA) in reducing use of and expenditures for cyclooxygenase-2 (COX-2) inhibitors. Study Design: Before and ...

Prior authorization requirements have been criticized for creating red tape, delaying care and denying services that should have been covered.