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 ...

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 need to fix healthcare’s antiquated prior authorization (PA) process remains a hot-button issue in the industry, garnering policy attention and spurring the development of myriad technology ...

Use of prior authorization in the Medicare Advantage (MA) program continues to increase, according to a report from KFF. More than 46 million prior authorization requests were submitted to Medicare ...

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 ...

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 ...

This was a question that Chris Severn, CEO of Turquoise Health, a price transparency company, asked of Don Antonucci, CEO of Providence Health Plan at a fireside chat in Las Vegas. The chat was part ...

-- 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 ...

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.

UnitedHealth Group and Cigna are revamping their prior authorization processes as new federal regulations aiming to ease the burden on providers and patients loom. UnitedHealthcare will eliminate ...

There is a good reason for health insurers to occasionally require prior authorization for medical treatment. If a doctor ...

The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients. Objective: Prior authorization ...