Delaware is using funding from last year's Republican budget law to launch a first-of-its-kind effort to standardize and ...

Seven years in, supporters hope the answer is finally yes ...

Ramya Ganti is the founder and CEO of Oprox, a VC-backed AI-native revenue intelligence platform for healthcare providers.

The letter to the CMS from Democrats is the latest salvo from lawmakers concerned that WISeR is delaying care to Medicare ...

A new pilot program bringing prior authorization, including using AI to review requests for care, to parts of traditional Medicare is off to a shaky start.

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action. Whether these ...

A new analysis from KFF and Health Management Associates takes a dive into prior authorization practices for Medicaid managed care organizations. The study polled state programs on policies in place ...

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 ...

Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your ...

Legislation aimed at reducing delays when Medicare Advantage plans require preapproval for care could hit the House floor under fast-track rules for bills that have broad support. The bill, sponsored ...

Few readers would be surprised to read that Americans are dissatisfied with their health care coverage — an outrage that the December 2024 assassination of UnitedHealthcare CEO Brian Thompson arguably ...