Prior Authorization
Expert articles and analysis related to prior authorization.
AI Summary — Last 7 Days
Over the past week, significant tensions have emerged surrounding Medicare policies, particularly concerning prior authorization practices and non-opioid pain treatment coverage. The American Society of Anesthesiologists and bipartisan lawmakers are vocally opposing proposed Medicare cuts that threaten the coverage of peripheral nerve blocks for chronic pain, which underscores the complexity of balancing cost control and patient care in value-based care models. Additionally, discussion surrounding health plans' commitments to simplification of prior authorization processes is gaining momentum, suggesting that stakeholder pressures may influence future CMS policies aimed at reducing administrative burdens on providers and enhancing patient access to necessary treatments, as evidenced by AHIP's latest stance. As the new Trump administration unveils its agenda, these ongoing discussions will be crucial for ACOs and other value-based care stakeholders navigating upcoming policy shifts.
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Health plans’ commitments to simplify prior authorization for patients and providers  AHIP
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ZeOmega Recognized in the 2026 Gartner(R) Market Guide for Intelligent Prior Authorization, U.S. Healthcare Organizations
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Payers, providers face challenges in meeting Interoperability and Prior Authorization Final Rule
The payer tactics quietly breaking ASC economics
ASC leaders far and wide agree payers have the upper hand in reimbursement negotiations, but each has their own take on which particular set of tactics is doing the worst damage to the economics of ou...
Payers, providers face challenges in meeting Interoperability and Prior Authorization Final Rule
LAS VEGAS – Ten percent of payers and 33% of providers have not yet started work on Prior Authorization Application Program Interface requirements, according to survey results released by the Workgrou...