One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now. Alex Shteynshlyuger, M.D., ...

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 ...

There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

Recently two members of our family had to obtain prior authorization from their health insurance. One person wanted a knee replacement by an orthopedic surgeon and his request was approved; the other ...

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 new KFF report found that payers either fully or partially denied 4.1 million prior authorization requests in 2024, or ...

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.

Physicians groups on January 17 hailed a new federal rule requiring health insurers to streamline and disclose more information about their prior authorization processes, saying it will improve ...

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 ...