Administrative costs are estimated to make up between 20 and 34 percent of US health care expenditures, roughly 1–4 percent of GDP. Academic and policy discussions generally characterize these costs ...

Centers for Medicare and Medicaid Services put forth a new set of rules to curb private insurance's use of prior authorization. These new rules will go into effect in 2026 and will impact care for the ...

U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz met with industry leaders to discuss their pledge to streamline ...

WASHINGTON — Health and Human Services Secretary Robert F. Kennedy Jr. said Monday that the country’s largest health insurers have promised to take steps to streamline the often-criticized prior ...

If you’ve ever been a patient waiting—days, sometimes more than a week—for treatment approval, or a clinician stuck chasing it, you know what prior authorization feels like. Patients sit in limbo, ...

The nation’s major health insurers are promising to scale back and improve a widely despised practice that leads to care delays and complications. UnitedHealthcare, CVS Health's Aetna and dozens of ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

Ahead of a final rule that would limit the amount of time insurers have to approve prior authorization requests and would require an electronic, FHIR API standard, UnitedHealth Group on Wednesday said ...

A report by the Office of Inspector General (OIG) finds Medicaid managed care members may not be receiving all medically necessary services. Medicaid managed care organizations (MCOs) denied one out ...

When your doctor decides you could benefit from a particular test or procedure, your insurance company might require documentation to prove it's necessary before agreeing to pay for anything.