The Centers for Medicare and Medicaid Services (CMS) has implemented prior authorization requirements for certain traditional ...

Forty-eight insurers, including major players, pledged to reform prior authorization processes to improve patient care access. The initiative includes technology standardization, reducing PA ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

To combat growing criticism of prior authorization delays by payers, Centers for Medicare & Medicaid Services finalized a rule Wednesday that requires health plans to send prior authorization ...

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 ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

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.

More than half of providers and 43% of payers have yet to start work on the application programming interface requirements of the interoperability and prior authorization final rule, according to a ...