Prior authorization (PA) is a widely used insurance mechanism intended to ensure cost-effective, evidence-based care. However, in practice, it often imposes significant administrative and clinical ...

New Medicaid prior-authorization rules have advocates in Connecticut concerned about patients losing access to their ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

Prior authorization has long been a sticking point between payers and providers, with payers arguing that it’s necessary to control costs and ensure that care is medically necessary and providers ...

Prior authorization is no longer just an administrative hurdle for ASCs; it is a defining constraint on growth. As authorization requirements expand, policies shift and payer scrutiny intensifies, ...

Health and Law flat lay. Judge gavel, medicine and doctor coat on blue, background, top view. Medical malpractice, personal injury attorney. Prior authorization has caused significant frustration for ...

Here are 10 things for ASCs to know regarding prior authorization in 2024: 1. CMS updated its interoperability and prior authorization final rule at the beginning of the year. The rule requires payers ...

California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...

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 ...

Ask a provider what’s causing tension in their relationship with insurers and many will point to prior authorization, arguing that the practice creates administrative burdens and delays in patient ...

Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully ...