Medicare in January will begin AI-powered pre-treatment reviews for select health services in a major policy change that's aimed at rooting out unnecessary care — but alarming providers. Why it ...
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 ...
The requirements will make exchanging health data more efficient and reduce administrative burden. Today CMS finalized the Interoperability and Prior Authorization Final Rule, continuing its efforts ...
It's no secret that burnout is a struggle across the healthcare industry, and the complex, time-consuming prior authorization process is one contributor. In fact, the U.S. Surgeon General addressed ...
The Biden administration released a proposal which, if finalized, would mandate Medicare Advantage (MA), Medicaid managed care, Affordable Care Act (ACA) plans and state Medicaid agencies implement ...
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 ...
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A Medicare program in Texas will use AI to approve or deny certain services. Here's what to know.
Artificial intelligence will soon be used for prior authorization for certain Medicare services in Texas and five other ...
Aetna provided an update on its efforts to streamline the healthcare experience on Thursday, one year to the day after the fatal shooting of UnitedHealth’ s top insurance executive sparked a wave of ...
The Centers for Medicare and Medicaid Services finalized the CMS Interoperability and Prior Authorization Rule on Wednesday. CMS said the rule will improve the prior authorization process and save ...
Sometimes certain types of specialty care and prescription drugs require special review called prior authorization to make sure they are right for the patient. Prior authorization is a standard ...
Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or ...
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