The Centers for Medicare & Medicaid Services April 10 released a proposed rule that would establish electronic standards for ...

CMS has proposed extending its prior authorization interoperability framework to cover drugs for the first time, building on its 2024 rule that focused on medical items and services. The proposed rule ...

The Trump administration has issued a proposed rule that aims to significantly overhaul prior authorization for ...

The impact of using AI to evaluate these prior authorizations is unclear. AI could allow tech companies to automatically approve more cases, which could speed up decisions. However, companies could ...

A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public ...

The feds have AI reviewing whether claims through traditional Medicare are 'medically necessary' — upending longstanding ...

Tennant had been diagnosed with stage 4 cholangiocarcinoma, a rare cancer that attacked his bile ducts before spreading to ...

US health insurers are advancing toward real-time prior authorization decisions by 2027 after reducing request volumes by 11%, eliminating 6.5 million transactions in 10 months. Insurers are working ...

An Orange County man has pleaded guilty to submitting nearly $270 million in fraudulent claims over an 11-month span to ...

Buyers are eyeing Gemini’s UK and EU units for regulatory access after layoffs, overseas retrenchment, and a stock collapse.

Prior authorization, Medicare Advantage requirements and quality reporting are among the leading drivers of practices’ ...

The recent disputes offer a lesson: in the eyes of copyright law, popularity is never a pass. Neither fame nor fandom nor the excuse of an "honest mistake" justifies unauthorized use. Music thrives on ...