Prior Authorization
Expert articles and analysis related to prior authorization.
AI Summary — Last 30 Days
Congressional Democrats are escalating efforts to terminate CMS’ WISeR model, a Trump administration Medicare experiment using AI-enabled prior authorization for selected services, arguing it could delay or deny care for seniors; for ACOs and other VBC participants, the fight signals that utilization management automation is becoming a central policy battleground between cost control, clinical autonomy, and beneficiary protection (STAT, Healthcare Dive). At the same time, CMS is pushing broader electronic prior authorization infrastructure, creating a strategic tension for payers and providers: administrative simplification and faster decisions may support risk-based care, but AI-driven denials and opaque criteria could intensify provider burden, patient access concerns, and regulatory scrutiny across Medicare Advantage, ACO-aligned networks, and specialty care pathways.
Related Articles
Expert: Can Health Systems Meet CMS’s 24-Hour Prior Authorization Rule?
The unraveling of prior authorization: 5 things to know
Prior authorization has been under intense scrutiny in recent months as frustration brews among clinicians and legislators aim to curb the use of AI technology in the practice. Here are five recent d...
Congressional Democrats try to force a vote to end Medicare AI prior authorization pilot
Congressional Democrats are mounting a fresh effort to end a Medicare experiment to use AI to approve or deny care.
Senate Democrats move to roll back Medicare AI prior authorization pilot
Lawmakers introduced a resolution to end the WISeR model, which Democrats say is delaying and denying care to seniors.
Health systems join payers as early adopters of electronic prior authorization
AMA survey shows physicians, patients continue to be heavily burdened by prior authorization
AMA survey shows physicians, patients continue to be heavily burdened by prior authorization American Hospital Association
CMS launches initiative to speed electronic prior authorization adoption
The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.
Physicians skeptical of insurer pledges to reform prior authorization: survey
Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by major insurers last year to reform prior authorization would result in any meaningful d...
Health systems join payers as early adopters of electronic prior authorization
Providers AtlantiCare, Bon Secours Mercy Health, Cleveland Clinic, Froedtert ThedaCare, Ochsner Health, Providence, Rush University System for Health, Sanford Health and Tennessee Oncology have joined...
Modern Healthcare: CMS Touts New Electronic Prior Authorization Plan Ahead Of 2027
From newsletter: Morning Briefing: Thursday, May 14, 2026 Morning Briefing: Thursday, May 14, 2026 Medicaid data for deportation, midwife licensing, hantavirus, CMS announcements, overdose deaths, doc...