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 ...

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 ...

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 ...

California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...

-- Aetna provided an update on its efforts to streamline the healthcare experience on Thursday, one year to the day after the fatal shooting of UnitedHealth’s top insurance executive sparked a wave of ...

Many private health insurers require medical providers to get approval before administering treatment, sometimes resulting in delayed or denied care for patients. Now, that tactic, known as prior ...

It's no secret that burnout is a struggle across the healthcare industry, and the complex, time-consuming prior authorization process is one contributor. In fact, the U.S. Surgeon General addressed ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

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 ...

Prior authorization is no longer just an administrative hurdle for ASCs; it is a defining constraint on growth. As authorization requirements expand, policies shift and payer scrutiny intensifies, ...

Physicians and other medical providers will tell you that prior authorization is out of control and has transcended any legitimate rationale.