"Medically necessary" is often a four-letter word for patients.

While the cost of health care remains the dominant worry among Americans, the process of obtaining prior authorization from ...

From prior authorization delays to PBM reforms and Medicaid gaps, experts track policy shifts that shape health equity and ...

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

Prior authorizations are required by insurance companies for some medications. This includes those that may have less expensive alternatives. The prior authorization process can take anywhere from a ...

Optum has launched a pair of AI-driven prior authorization products, one designed to speed up submissions on the provider side and another to accelerate clinical reviews for payers. The ...

The intelligent automation will deliver more timely decisions that reduce delays and improve access to care, Optum says.

Patients view prior authorization as the biggest burden in navigating the healthcare system, according to a new KFF poll. | Patients view prior authorization as the biggest burden in navigating the ...

The CMS Final Rule signals a future in which prior authorization isn’t just faster but fairer. AI has the potential to accelerate decisions, lower administrative costs and support equitable access to ...

The Centers for Medicare & Medicaid Services (CMS) has been using prior authorization for selected Hospital Outpatient Department (OPD) services ...

Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully ...