Inappropriate denials for prior authorization and coverage of medically necessary services are a pervasive problem among ...

CMS issued the 2026 Medicare Physician Fee Schedule, or PFS, proposed rule on July 14.It includes a 0.75% increase to the ...

States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics ...

Humana (NYSE:HUM) on Tuesday announced plans to reduce approximately one-third of prior authorizations for outpatient ...

The Coalition for Health AI is convening a fast-tracked, priority team to determine how AI could best be used to implement ...

About 68.5 million Americans are currently enrolled in some type of Medicare plan, with about 90% of enrollees being over age 65, according to the Centers for Medicare & Medicaid Services.

Last December, CMS announced that the two SCD gene therapy manufacturers -- Vertex Pharmaceuticals and bluebird bio -- agreed to participate in the model.

The Trump Administration is bringing prior authorizations (PAs), the mandatory preapproval before insurance covers health ...

A new CMS model will introduce new prior authorization requirements to traditional Medicare in six states, raising provider concerns about administrative burden.

The Centers for Medicare and Medicaid Services (CMS) will implement prior authorization requirements for certain traditional fee-for-service Medicare services in six states starting next year.

CMS is adding prior authorization requirements for certain fee-for-service procedures under traditional Medicare as part of its new Wasteful and Inappropriate Service Reduction model. A total of 17 ...

Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.