The idea behind it seems reasonable: Insurers want to ensure treatments are medically necessary before they pay for them. But ...

There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

St. Peter’s Healthcare System prepared its staff and processes for the new Medicare prior authorization pilot starting January ...

One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now. Alex Shteynshlyuger, M.D., ...

Prior authorization has emerged as a flash point between payers and providers as the former tries to manage what they believe is waste in the system while the latter accuses payers of trying to deny ...

One increasingly subtle but important theme in US healthcare is the shift to care allocated by payers rather than providers. Historically, decisions on what care to provide patients were made by ...

Payer updates and policy changes delay reimbursement; Leaders say automated solutions can help fight back. The tug-of-war between providers and payers over prior authorizations is a consistent and ...

Initially meant to protect patients from unnecessary procedures, prior authorizations have shifted towards being a cost containment strategy for health payers. This shift is causing significant ...

The Journal of Clinical Oncology podcast, hosted by Dr. Shannon Westin and Dr. Davide Soldato, presents analyses and discussions centered on the latest findings published in ASCO’s esteemed Journal of ...

When you are sick or in pain, the prior authorization process can be frustrating and will sometimes result in a denial. If you've never been through the process, prior authorization is a requirement ...

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.

The prior authorization process has been debated by physicians, hospitals, health plans and even the government for a number of years. What about this particular moment made it time to act and lean ...