Patient Access API and prior authorization decision timeframes and denial reason requirements take effect in 2026. Effective Jan. 1, 2026, impacted payers will need to annually report metrics of ...

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 ...

Authparency.ai was recognized for its differentiated approach to solving one of healthcare's most persistent and costly problems: prior authorization. The administrative process, which delays patient ...

The CMS is once again tackling prior authorization in its new rule proposed Tuesday. Prior authorization, a process in which a physician must get the green light from an insurer for medication or ...

A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.

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 ...

A large portion of payers and providers have not started or are partially through implementing CMS API requirements, with compliance due by January 1, 2027. Key challenges include funding, developing ...

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JACKSONVILLE, Fla.--(BUSINESS WIRE)--Availity, the nation's largest real-time health information network, is at HLTH 2024, one of the most anticipated trade shows in healthcare, to showcase its ...

Strengthen your financial backup. Even with Medicare coverage, unexpected out-of-pocket expenses can pop up. Earn as much as ...

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences. Many states have adopted or are ...

Cigna is the latest health insurer to roll back prior authorization requirements, announcing Thursday that it will no longer require the approvals for nearly 25% of medical services. Cigna plans to ...