The Wasteful and Inappropriate Service Reduction initiative from CMS is set to take effect Jan. 1, 2026, introducing new prior authorization requirements for select services. Here are seven things to ...

AHA has “substantial concerns” over the vendor payment structure in WISEeR that incentivizes denials at the expense of ...

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 ...

It’s a situation all of us will find ourselves in at some point. You’re sick, or get diagnosed with a chronic condition, or need to have surgery. Thankfully, your physician diagnosed the issue quickly ...

They found that the automated diabetes GLP-1 prior authorization proportion of all diabetes GLP-1 claims grew by 17.5 percentage points, or 39.6%, from October 2024 to July 2025.

When you are sick or in pain, the prior authorization process can be frustrating and will sometimes result in a denial. If you've never been through the process, prior authorization is a requirement ...

The aggravating prior authorization process includes one step that merits scrutiny and potentially regulatory action: the ...

Medicaid Managed Care Organizations (MCOs) denied one out of eight prior authorization requests in 2019, according to a new report from the Office of Inspector General (OIG). The OIG review included ...