While more plans have turned to gold carding as a method for streamlining prior authorization for medical services in the past three years, the approach has a mixed success rate, according to an AHIP...
Medicaid fee-for-service (FFS) programs were more likely to cover medications for opioid use disorder (MOUD) but imposed more prior authorizations for the treatments compared to Medicaid managed care...
Beneficiaries may face barriers to substance abuse care when states impose prior authorizations for substance use disorder treatments, but a broad range of policies can influence Medicaid...
Medicare Advantage beneficiaries express high levels of member satisfaction, an eHealth survey found.
eHealth surveyed nearly 2,850 individuals online toward the end of May 2022.
Nearly two-thirds of...
Better Medicare Alliance (BMA) has endorsed HR 3173, the Improving Seniors’ Timely Access to Care Act, a law that seeks to reform prior authorization in Medicare Advantage.
“When it comes...
Updated 5/13/2022: This article has been corrected to adjust the name of the company which was incorrectly referred to as "Arcadia.io" throughout its section of the article. The company is...
Medicare Advantage plans have incorrectly denied or delayed prior authorizations or payment requests and, in doing so, have accrued unwarranted revenues, according to a report from the Office of...
Certain utilization management techniques—such as step therapy and prior authorization—may increase employees’ costs and restrict access to care, especially for employees with chronic...
CalOptima—a county-organized health system that offers care through public payer coverage, including Medicaid, Medicare Advantage, and Medicare-Medicaid plans—is launching a five-year...
For certain diseases, some payers implement step therapy protocols that are stricter than clinical and regulatory entities have recommended, researchers found in a Health Affairs study.
“Step...
CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant.
“The ability of hospitals to transfer patients to...
Updated 7/08/2021: This article has been updated to include a comment from an Aetna spokesperson.
Ophthalmologists are responding in opposition to Aetna’s new prior authorization policy for...
Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact...
As new cases of COVID-19 peaked in late 2020, most physicians reported that payers had either reinstated prior authorization policies or never relaxed policies to begin with, based on an American...
After collaborating for 18 months on streamlining data exchange between health plans, patients, and providers, Humana and Epic are moving into the next phase of their partnership which involves...
Electronic prior authorizations may improve quality of care by increasing the speed of care delivery, decreasing provider burden, and boosting patient experience, according to a study conducted on...
Obstetrician-gynecologists (OBGYNs) experience reimbursement and referral challenges for care provided to Medicaid beneficiaries, according to a new nationally representative survey of OBGYNs conducted...
Same-sex couples are increasingly gaining access to employer-sponsored same-sex spousal coverage, but benefits remain less accessible than for heterosexual couples, a recent Kaiser Family Foundation...
Most states have had to expand their Medicaid long-term supports and services coverage and benefits in order to protect some of the most vulnerable populations from the coronavirus, which could have...
Payers have not lived up to their promise to improve the prior authorization process, the American Medical Association (AMA) charged in a recent statement.
In 2018, groups including America’s...
