Sometimes certain types of specialty care and prescription drugs require special review called prior authorization to make sure they are right for the patient. Prior authorization is a standard ...

A look at the rise of prior authorization certified specialists (PACS)—and their value in improving patient access and outcomes. The healthcare industry constantly grapples with the challenge of ...

Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. On June 27, 2025, the Centers for Medicare and Medicaid ...

If there’s one thing healthcare providers can agree on, it’s that prior authorization management is a heavy administrative burden and only growing heavier. Decades ago, it was created to ensure care ...

An insurance company often requires this type of preapproval for certain services, procedures, prescription medications, and medical supplies. Your healthcare team can often help you navigate this ...

Since January, 10 states have passed laws reforming prior authorization rules in an effort to reduce care delays and save time for physicians and patients, according to an Aug. 19 report from the ...

The administrative costs of healthcare, including prior authorizations, are estimated to make up 20 to 34 percent of healthcare expenditures, according to an Aug. 4 report from the American Enterprise ...

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.

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest. As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist ...

Health and Law flat lay. Judge gavel, medicine and doctor coat on blue, background, top view. Medical malpractice, personal injury attorney. Prior authorization has caused significant frustration for ...