CMS has unveiled the Wasteful and Inappropriate Service Reduction model, a new Innovation Center initiative that will add prior authorization for some traditional fee-for-service Medicare services.

Rep. Lois Frankel said she is pushing back against a movement to add prior-authorization requirements to Medicare and to use ...

Health plan executives expect AI to automate prior authorizations, improving turnaround times amid CMS regulatory changes, ...

Beginning Jan. 1, 2026, 17 medical procedures will require prior authorization for patients under the traditional Medicare ...

The Centers for Medicare and Medicaid Services (CMS) recently announced the launch of a program that will require individuals on Medicare to obtain prior approval from the federal health insurance ...

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 ...

The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) sets a new standard for how payers exchange data and respond to authorization ...

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced an agreement with Medicare Advantage plans to lessen the use of prior authorization, but the agency also said it would ...

What are the top initiatives in your payer organization? Enhancing your Star ratings? Strengthening your provider network? Addressing health equity issues? Gartner’s most recent healthcare benchmark ...

Staff at Arkansas' Harmony Park Family Medicine have been excited about streamlining the prior authorization process with the goal of improving patient access to high-quality care. Prior authorization ...