KFF: Insurers Denied 12%-18% of Prior Authorization Requests in 2025
KFF found that insurers denied 12%-18% of standard prior authorization requests in 2025, with significant variation among insurers and gaps in transparency.
Prior Authorization Is Draining Revenue: Why Automation Has Become a Strategic Imperative
When staff are overextended and patients face delays or abandon care, the issue is no longer a narrow administrative burden. It becomes a business, financial, and access challenge that demands a different operating model.
Where Will AI Deployment Benefit Payers the Most?
We are taking a look at how health insurers are using AI, defining success, and managing cybersecurity risks. Give us your opinions by completing our brief, anonymous survey.
The ‘Bot Vs. Bot’ Dynamic Between Providers & Payers Is Driving Up Costs for Everyone
HSS chief digital and information officer Ashis Barad, who has worked on both the payer and provider sides of healthcare AI, thinks the industry's growing "bot vs. bot" battle over prior authorizations and appeals is driving costs up. To him, the real fix lies in providers and payers sharing data to build more personalized care pathways.
Healthcare Groups Praise Unanimous Committee Approval of MA Prior Auth Bill
The House Ways and Means Committee unanimously advanced a bill to reform Medicare Advantage prior authorization requirements.
Prior Authorization is a Fight and AI Won’t End It — Stop Pretending Otherwise
The honest question is not whether AI will end the fight. It will not. The honest question is what AI does to a fight that has been structurally imbalanced for 30 years.
UnitedHealthcare Threw Open Its HQ to Journalists and Influencers. Why?
UnitedHealthcare CEO Tim Noel, Optum CEO Dr. Patrick Conway, and other top executives and employees gave unprecedented access to journalists and others in order to show how the company is trying to reduce friction in healthcare. The goal was to change hearts and minds. Did the insurance behemoth succeed?
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Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Why So Few Appeals Happen and What That Reveals About Health Plans
Appeals and grievances reflect how well a health plan functions under pressure. They also show how effectively your organization can surface, prioritize, and resolve the cases that matter most.
Is It Likely That the WISeR Model Will be Repealed?
Congressional Democrats are seeking to repeal the controversial WISeR model, but experts are unsure if their efforts will succeed.
Don’t Leave Healthcare’s Greatest Asset Behind on the Road to Interoperability
In the push toward a more seamless, digitally enabled future, it’s important we understand exactly how this rush to interoperability may actually harm patients, instead of helping, and what we can do to make sure they keep pace.
OIG: 3 Largest MA Insurers Deny Prior Auth Requests at High Rates for Long-Term Acute Care, Inpatient Rehab
An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024.
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The Healthcare Payments Industry Faces a Perception Challenge
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
The 72-Hour Hurdle: Faster Prior Authorization is Exposing Healthcare’s Broken Billing Cycle
The healthcare ecosystem is fixing how quickly decisions get made, without fixing how quickly money actually moves. This isn’t a failure of reform. It’s evidence that reform is working — and revealing where modernization needs to continue.
Only 33% of Physicians Believe Health Plans’ Prior Auth Commitments Will Make a Difference
A new American Medical Association survey found that most physicians remain skeptical that insurers’ recent prior authorization reform commitments will meaningfully reduce delays, administrative burdens or patient harm.
Digitizing Medical Policy Alone Will Not Automate Prior Authorization at Scale
Many health plans are discovering that even after digitizing medical policies and implementing FHIR APIs, prior authorization turnaround times remain slow and provider frustration remains high. The reason is straightforward: digitization alone does not make medical‑necessity determinations executable by automated systems at scale.
‘Prior Authorization’ Has Become a Dirty Word in Healthcare, But it Might Be Medicare’s Smartest Path Forward
Since its inception, AI in prior auth has only been at work in the commercial healthcare marketplace. Now new innovative approaches that reframe prior auth as a resource instead of a roadblock have come to Medicare via the WISeR model.
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MedCity Pivot Podcast: Modernizing Prior Auth
In this episode, MedCity News' Arundhati Parmar chats with a pharmacy benefits leader and a virtual pharmacy operator about ways to modernize and scale prior authorization.