For many physician practices -- especially those working with health maintenance organizations (HMOs) -- obtaining pre-authorization to perform certain treatments or procedures is a necessary evil: ...

Medicare Advantage (MA) insurers that impose prior authorization requirements on doctors in accountable care organizations (ACOs) should have to get them pre-approved by CMS, Sen. Sheldon Whitehouse ...

Major health insurers in the U.S. pledged Monday to overhaul the prior authorization process. Prior authorization means insurers require approval before they’ll cover medical care, a prescription or a ...

Sometimes a health insurer will require preauthorization of a medical procedure, and as a result may deny that pre-authorization, keeping the patient from getting the care they need, at least ...

The U.S. Department of Health and Human Services has secured a pledge from insurers to streamline the companies’ practice of requiring prior authorizations before covering a claim. “Americans ...

The policies include advocating for increased legal accountability for payers when prior authorization harms patients, according to a June 11 AMA news release shared with Becker’s. The AMA will also ...

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.

State insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements for “many routine and essential” health care services, Gov. Maura Healey announced ...

CMS is launching a five-year Prior Authorization Demonstration for certain ambulatory surgical center (ASC) services beginning December 15, 2025, in 10 states, including Georgia, Florida, Tennessee, ...