Prior authorization forces doctors to spend 13 hours a week fighting insurers. New federal rules are changing that. Here's ...

HHS is proposing to adopt certain HL7 FHIR standards and implement specifications for transactions related to prior ...

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 ...

A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public ...

Some Medicare recipients are set to experience a new “prior authorization” measure as the Centers for Medicare & Medicaid Services (CMS) trials its much-discussed “Wasteful and Inappropriate Service ...

US health insurers are advancing toward real-time prior authorization decisions by 2027 after reducing request volumes by 11%, eliminating 6.5 million transactions in 10 months. Insurers are working ...

For decades, Americans have endured a healthcare system where access to care is delayed not by clinical need, but by administrative demands with little benefit. Prior authorization, the process ...

Major health insurance providers have agreed to reduce the need for prior authorization — the requirement that patients must get approval from insurers before receiving certain treatments or risk ...

Issued Friday, the proposed rule also would require full disclosure of claims denials and appeals outcomes, according to a ...

June 23 (UPI) --Major American insurers announced Monday that they have agreed to speed up and smooth out the processes involved with the reception and administration of health care by streamlining ...

The fifth annual Abarca Forward conference, hosted by the pharmacy benefit manager (PBM) Abarca Health at its headquarters in ...

Between one-off charges, administrative fees, and office visit copays, some are trying ...