If you’ve ever been a patient waiting—days, sometimes more than a week—for treatment approval, or a clinician stuck chasing it, you know what prior authorization feels like. Patients sit in limbo, ...

While there's a lot of buzz around prior authorization, it applies to fewer than 2% of claims. Prior authorization ensures care is both safe and aligned with the most up-to-date clinical guidelines.

Navigating the healthcare system can be a complex and frustrating experience for many patients. Among the many challenges, one of the most insidious barriers to timely care is prior authorization.

Prior authorization has emerged as a flash point between payers and providers as the former tries to manage what they believe is waste in the system while the latter accuses payers of trying to deny ...

The new Medicare initiative would apply to claims for procedures such as steroid injections for pain management, electrical nerve stimulator implants, skin and tissue substitutes, devices for ...

The AI-powered prior auth requirements under the CMS' Wasteful and Inappropriate Service Reduction model would increase ...

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.

The WISeR model – intended to reduce spending on seniors in traditional Medicare through Wasteful and Inappropriate Service Reduction – will require prior authorization in traditional Medicare for a ...

CLEVELAND, Ohio — A new Medicare pilot program set to launch next year in Ohio and other states could change the way older Americans access certain medical treatments, drawing sharp criticism from ...