Prior Authorization
Expert articles and analysis related to prior authorization.
AI Summary — Last 7 Days
Prior authorization pressure intensified across Medicare Advantage and commercial markets, with CMS under the Trump administration accelerating electronic prior authorization implementation while hospitals and physicians continue pushing for stronger MA prompt-payment and denial guardrails. The week’s core tension is that payers are trying to show voluntary progress—e.g., UnitedHealth plans to eliminate nearly two-thirds of pediatric prior auths—while providers remain skeptical amid reports of delayed/denied MA care, AI-driven review concerns, and renewed hospital advocacy around MA reform and payment timeliness. For VBC leaders, the operational signal is clear: prior auth automation, AI oversight, and MA utilization-management performance are becoming central to network strategy, downside-risk economics, and patient access management, not just administrative burden reduction ([CMS electronic prior auth push](https://news.google.com/rss/articles/CBMizAFBVV95cUxQZE1jeFlRTVpPZTJldkNDaEZQLXZTOHlFQzJ4QkE2TWlsdWZ1V0VOSzQzOVRMcVVaUE5jYmZmcXJKMkRlQ2xVYjNuRTl4ZmhDMFVkM0FMRnRqOTdHTW00YnN4aTJ3ZDFtc1F0bEJXOE9ObTZuYnl6T21LYnIwVVE5SGhQcDRMeTFyamV3d0Qx
Related Articles
UnitedHealthcare eases pediatric care prior authorization requirements
UnitedHealthcare has announced that it is removing two-thirds of authorization requirements for pediatric care by year's end.The insurer is eliminating prior authorizations for care for members under ...
UnitedHealth to nix nearly two thirds of pediatric prior auths
UnitedHealth to nix nearly two thirds of pediatric prior auths  Fierce Healthcare
Prior auth reform: We’ll believe it when we see it, physicians say
CMS Accelerates Efforts To Support Health System-Wide Electronic Prior Authorization - open minds
CMS Accelerates Efforts To Support Health System-Wide Electronic Prior Authorization  open minds
Prior authorization is draining revenue, which is why automation has become a strategic imperative
Prior authorizations have entered a different era. The process has become one of healthcare’s most expensive administrative bottlenecks, affecting far more than physician practices. Across hospitals a...
UnitedHealthcare drops some prior auth requirements for cardiology, orthopedic services
UnitedHealthcare drops some prior auth requirements for cardiology, orthopedic services  Becker's ASC
Washington seniors face denied, delayed care under AI Medicare review program
Washington seniors face denied, delayed care under AI Medicare review program  Oregon Public Broadcasting - OPB
UnitedHealthcare to scale back pediatric prior auth requirements
UnitedHealthcare to scale back pediatric prior auth requirements  Becker's Hospital Review