The case of one Maine woman shows how prior authorization rules can block coverage for even simple, medically necessary care.

Humata will serve as Oklahoma's primary technology partner, processing all WISeR prior authorization requests for providers across the state. The company will intelligently apply existing Medicare ...

While the AHA has called on CMS to rethink its plan to add prior authorization requirements to traditional Medicare, some argue that the program is due for some utilization management.

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 ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

Many private health insurers require medical providers to get approval before administering treatment, sometimes resulting in delayed or denied care for patients. Now, that tactic, known as prior ...

The new CMS regulations on prior authorization have been heralded as a big step forward in reducing administrative burdens on physicians, but some people think it doesn't go far enough. The CMS ...

Therapists treating Medicaid enrollees in Colorado will have to get the state’s authorization to conduct more than 24 sessions with an individual patient in a year, as the department overseeing the ...

A new federal program asks Ohio doctors to request prior approval from contracted technology companies to get certain medical treatments covered by traditional Medicare. A new federal program called ...