Medicare Advantage plans use prior authorization to manage health care use. In recent years, these practices have come under intense scrutiny from policy makers. Using beneficiary enrollment data and ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

Ramya Ganti is the founder and CEO of Oprox, a VC-backed AI-native revenue intelligence platform for healthcare providers.

Insurance companies often make doctors ask their permission before treating patients. This template can help medical professionals explain how it works. By Ron Lieber Ron Lieber will update this ...

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 ...

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior ...

UnitedHealthcare is eliminating authorization requirements for 30% of healthcare services that previously required insurer approval, the nation's largest insurer said. Prior authorization is currently ...

A new CMS proposed rule would reduce the burden of prior authorizations by further shortening payer decision timeframes and ...