The Centers for Medicare & Medicaid Services has proposed a 2026 rule to modernize and speed up prior authorization for drugs ...

Athenahealth and CoverMyMeds joined forces to streamline how patients receive prescriptions that require prior authorization from payers. Athenahealth integrated CoverMyMed’s electronic prior ...

The CMS 2026 Prior Authorization Rule, effective January 2026, mandates payers in Medicare Advantage, Medicaid, CHIP, and ACA markets to adopt FHIR-based APIs, electronic prior authorization, and ...

Prior authorization has become one of the clearest points where administrative complexity directly affects patient care. For ...

Prior authorization requirements cost the U.S. healthcare system an estimated $35 billion each year, and their overuse has triggered a backlash, stirring some policymakers into action. Whether these ...

The relationship between payers and providers has been historically contentious, with prior authorization being one of the biggest pain points. The process remains a heavily manual and costly burden ...

RadNet is a national radiology provider with 344 imaging centers employing 8,000 people and 500 radiologists. It has regional networks in New Jersey, New York, Delaware, Maryland, California and ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...

Prior authorization is the process by which your doctor must request approval from your Medicare plan before they can order a particular medication or medical service. Generally, Original Medicare ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

This guide breaks down what separates enterprise-grade HME/DME billing platforms from glorified spreadsheets, which features actually move the needle on reimbursement rates, and how to evaluate ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...