Medicare enrollees in Texas will soon be required to get prior authorization for certain medical services – and artificial intelligence will play a central role in those decisions. Beginning Jan. 1, a ...

Aetna has announced it is integrating pharmacy prescriptions and medical procedures into a single clinical review to streamline the prior authorization process. The prior authorization bundles are for ...

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 ...

The critical pre-authentication RCE flaw is added to CISA’s KEV catalog, with a warning for federal civilian agencies to apply Oracle’s October patch by December 12. The Cybersecurity and ...

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We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

The lawmakers argue the CMS innovation center model, which will implement AI-backed prior authorization for some services in six states, will add red tape and limit access to care. The bill, called ...

While the headaches and life-altering results of insurance pre-authorizations are not new to physicians or patients, lately things have been getting worse. Patients are sending more and more messages ...

Recently, we put together a template to help medical professionals explain a confusing process. Readers gave us very pointed feedback, so we updated it. By Ron Lieber Two months ago, I shared my tale ...

A breast cancer diagnosis should trigger immediate action. But for many patients, the journey to treatment begins with delays, often caused by outdated prior authorization (PA) processes. Designed to ...

AI-driven prior authorizations (PAs) are trusted by many clinicians, promising to streamline processes and reduce administrative burdens. Concerns exist about AI increasing denial rates and lacking ...