The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and Inappropriate Service Reduction model.
The Centers for Medicare and Medicaid Services (CMS) recently announced the launch of a program that will require individuals on Medicare to obtain prior approval from the federal health insurance ...
Recently, we put together a template to help medical professionals explain a confusing process. Readers gave us very pointed ...
Prior authorization is “wreaking havoc” on patient outcomes, physician burnout and productivity, a recent American Medical Association survey found. The survey was conducted in December and asked ...
Major health insurance providers have agreed to reduce the need for prior authorization — the requirement that patients must get approval from insurers before receiving certain treatments or risk ...
A smart API broker and data integration engine. Plans must query multiple systems to determine whether prior authorization is required, from member eligibility to policy coverage to provider status.
In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.
GoodRx reports that starting January 2026, original Medicare will require prior authorization for certain services in six ...
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