Blue Shield is designing a centralized, machine-readable policy repository to enhance policy digitization and automation, speeding up prior authorization decisions. The organization has partnered with ...

CVS Health (CVS) announces major changes to its prior authorization procedures to ensure continuity of care for patients.

Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced an agreement with Medicare Advantage plans to lessen the use of prior authorization, but the agency also said it would ...

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 ...

Aetna has announced it is integrating pharmacy prescriptions and medical procedures into a single clinical review to streamline the prior authorization process. The prior authorization bundles are for ...

A year ago, the fatal shooting of a health insurance executive on a Manhattan sidewalk unleashed many Americans’ pent-up frustration with insurers’ delays and denials of care. UnitedHealthcare CEO ...

At least 18 states took action on health insurers’ use of prior authorization this year, a sign that lawmakers aren’t content to wait on federal regulators to step in on a key consumer and provider ...

Prior authorization (PA) is a utilization management technique used by health insurers that requires providers to seek approval from the insurance plan before the plan will agree to pay for a covered ...

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Leah Kovitch was pulling invasive plants in the meadow near her home one weekend in late April when a tick latched onto her leg. She did not notice the tiny bug until Monday, when her calf muscle ...

A new bill from Democratic lawmakers seeks to repeal a controversial bill from the Centers for Medicare and Medicaid Services that would put artificial intelligence at the forefront of medical ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...