There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into ...

St. Peter’s Healthcare System prepared its staff and processes for the new Medicare prior authorization pilot starting January ...

One physician is making the case that prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now. Alex Shteynshlyuger, M.D., ...

Prior authorization has emerged as a flash point between payers and providers as the former tries to manage what they believe is waste in the system while the latter accuses payers of trying to deny ...

Recently two members of our family had to obtain prior authorization from their health insurance. One person wanted a knee replacement by an orthopedic surgeon and his request was approved; the other ...

One increasingly subtle but important theme in US healthcare is the shift to care allocated by payers rather than providers. Historically, decisions on what care to provide patients were made by ...

Payer updates and policy changes delay reimbursement; Leaders say automated solutions can help fight back. The tug-of-war between providers and payers over prior authorizations is a consistent and ...

A recent proposal to report prior authorization to insurance plans through CPT codes was withdrawn at the eleventh hour when its physician advocate made an unexpected discovery: For certain codes and ...

While there's a lot of buzz around prior authorization, it applies to fewer than 2% of claims. Prior authorization ensures care is both safe and aligned with the most up-to-date clinical guidelines.

The prior authorization process has been debated by physicians, hospitals, health plans and even the government for a number of years. What about this particular moment made it time to act and lean ...

Imposing a new prior authorization requirement increased the likelihood that older patients with cancer will delay or stop filling their prescription for oral anticancer drugs, a new study showed.