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 ...

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prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now.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., ...

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 ...

Initially meant to protect patients from unnecessary procedures, prior authorizations have shifted towards being a cost containment strategy for health payers. This shift is causing significant ...

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 ...

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 ...

Imagine you and your gastroenterologist have discussed a new ulcerative colitis (UC) treatment plan that promises to reduce your symptoms and the stress that comes with them. Then, when you go to ...

Thomas Keane, MD, MBA, began his tenure as national coordinator for health information technology at HHS in June 2025. He sat down at his office with Washington Editor Joyce Frieden to discuss how he ...