Whether you're filling a prescription or scheduling a procedure, chances are you've been asked whether you have prior authorization. By learning to navigate prior authorization and what steps to ...

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prior authorization for procedures should be reported to insurance plans as a CPT code—though that proposal has been withdrawn for now.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., ...

CMS recently announced a new model it will be using to pilot the use of artificial intelligence and machine learning in reviewing prior authorizations submitted for certain services CMS has identified ...

In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior ...

The CMS will soon make it more difficult for providers in six states to get reimbursed in Medicare for certain medical procedures it has deemed “low value,” but some stakeholders worry it could lead ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

VIENNA, Va., Feb. 19, 2025 /PRNewswire/ -- careviso, a leader in healthcare technology solutions and prior authorizations (PA), today announced a strategic alliance with XiFin, a trusted leader in ...

Beyond prior authorization, Sun Knowledge Inc. provides comprehensive medical billing solutions to optimize revenue cycles, reduce denials, and ensure regulatory compliance. The company offers ...

Cigna Healthcare, the health benefits provider of the Cigna Group, will be removing close to 25% of medical services from prior authorization requirements, the insurer said today. With the removal of ...