Massachusetts insurance regulators unveiled sweeping prior authorization reforms that would scrap pre-approval requirements ...

The Biden administration released a proposal which, if finalized, would mandate Medicare Advantage (MA), Medicaid managed care, Affordable Care Act (ACA) plans and state Medicaid agencies implement ...

The Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization Final Rule (Final Rule) on Jan. 17, 2024. The Final Rule continues CMS' efforts to encourage ...

Obtaining prior authorization for prescription medications is a time-consuming process for prescribers, patients and pharmacists that currently requires phone calls, faxes and hard-copy request forms.

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 ...

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to ...

There are many points of friction along the patient journey, but prior authorization processing is among the most time-consuming, costly and frustrating of these stumbling blocks. Each year in the U.S ...

It's no secret that burnout is a struggle across the healthcare industry, and the complex, time-consuming prior authorization process is one contributor. In fact, the U.S. Surgeon General addressed ...

The American Hospital Association has sent a letter to the Centers for Medicare and Medicaid Services requesting that the latter revise proposed regulations regarding prior authorizations, citing ...

Under a final rule released today, impacted payers will be required to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. The Centers ...