Health insurers face a prior authorization prescription drug mandate similar to the rule imposed on claims, under a proposal released Friday by the Centers for Medicare & Medicaid Services. CMS is ...
A new CMS proposed rule would reduce the burden of prior authorizations by further shortening payer decision timeframes and ...
The proposed rule aims to improve prior authorization for prescription drugs by requiring electronic prior authorization, setting deadlines, and promoting transparency through annual reporting. The ...
Four major insurers showed almost no overlap in prior authorization requirements and no shared approval criteria or documentation rules, potentially contributing to the time and administrative burden ...
Artificial intelligence has become healthcare’s favorite scapegoat, especially in insurance. Every denied claim, every delayed approval, every inexplicable “not medically necessary” response seems to ...
LAS VEGAS – Ten percent of payers and 33% of providers have not yet started work on Prior Authorization Application Program Interface requirements, according to survey results released by the ...
Q2 2026 Black Book payer IT client scores recognize top performance in PA workflow control, UM execution, medical-policy governance, clinical decision support and 2027 readiness CHICAGO, IL / ACCESS N ...
The Centers for Medicare & Medicaid Services’ 2026 interoperability and prior authorization rules will require many payers to adopt FHIR-based APIs and electronic prior authorization capabilities by ...
Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action. Whether these ...
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 ...
Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...
Some results have been hidden because they may be inaccessible to you
Show inaccessible results