California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...

Prior authorization (PA) is a widely used insurance mechanism intended to ensure cost-effective, evidence-based care. However, in practice, it often imposes significant administrative and clinical ...

Nearly 53 million prior authorization requests were sent to insurers in 2024, compared with nearly 50 million in the prior year, according to KFF. Almost 8% of those requests were partially or fully ...

While the cost of health care remains the dominant worry among Americans, the process of obtaining prior authorization from ...

The pilot, launched in January 2026 in 6 states, could reduce wasteful spending, but increases provider paperwork and risks ...

Ohio is participating in a pilot program that will use artificial intelligence to determine approvals for around a dozen ...

"Medically necessary" is often a four-letter word for patients.

Transparency Scorecard to increase visibility into non-clinical dimensions of MA plan performance that fall outside the appropriate scope of Star Ratings.

Your office recently put out a request for information related to AI in healthcare. What are you hoping to learn from it?

Your doctor submits a claim to your health insurance. The claim is denied. You might be justified in thinking the denial is due to a medical disagreement. After all, adjudicating what health care ...

Payer scrutiny in spine and orthopedic care is intensifying, and surgeons say the biggest barriers to care come not from clinical uncertainty, but from rigid algorithms, prior authorization delays and ...

A summit hosted by Brown University’s School of Public Health brought together policymakers, researchers, health care leaders ...