As the year comes to a close, the Trump administration seems to be going in two different directions when it comes to the use ...

Medicare is launching a new pilot program that will require prior approval for 17 health services using artificial ...

More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or ...

Medicare in January will begin AI-powered pre-treatment reviews for select health services in a major policy change that's aimed at rooting out unnecessary care — but alarming providers. Why it ...

The idea behind it seems reasonable: Insurers want to ensure treatments are medically necessary before they pay for them. But in practice, it often means delayed appointments, stalled medication ...

From the denials to critical updates on 340B and prior authorization, here is a look back at the trends and tactics that defined the revenue cycle in 2025.

Artificial intelligence will soon be used for prior authorization for certain Medicare services in Texas and five other ...

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 ...

The National Council of Insurance Legislators (NCOIL) has adopted the Prior Authorization Reform Model Act at its 2025 Annual ...

In a recent survey, 84% of providers reported the number of medical services that require prior authorization has increased. And 62% of providers reported that they do not have the technology to ...

The requirements will make exchanging health data more efficient and reduce administrative burden. Today CMS finalized the Interoperability and Prior Authorization Final Rule, continuing its efforts ...

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 ...