A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

Strengthen your financial backup. Even with Medicare coverage, unexpected out-of-pocket expenses can pop up. Earn as much as ...

Medicare is launching a new pilot program that will require prior approval for 17 health services using artificial ...

Health insurance companies are expected to hold to their promises in 2026 to “streamline, simplify and reduce” prior ...

More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or ...

While the AHA has called on CMS to rethink its plan to add prior authorization requirements to traditional Medicare, some argue that the program is due for some utilization management. CMS has sparked ...

In October, CMS announced the launch of a new prior authorization demonstration that would introduce new requirements for select services. This comes just four months after news of an agreement ...

The program was first announced in June by Health and Human Services Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, ...

Several major health systems are dropping Medicare Advantage plans in the new year. The hospitals are ending their acceptance ...

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 ...

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 ...

UnitedHealthcare, facing a storm of backlash from docs over its decision to implement a policy that would require prior authorization for some surveillance and diagnostic colonoscopies, is pushing ...