Lawmakers Introduce Multiple Bills Aimed at Medicare Advantage Reform
Thirteen House Democrats introduced eight bills to rein in Medicare Advantage and bolster traditional Medicare.
Simplifying Patient Access And Building Trust Using AI
AI and advanced analytics can help organizations move beyond incremental fixes, streamlining access and improving patient experience, without overburdening staff or budgets.
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Enhanced Direct Enrollment: Georgia Access and the Power of Partnership
Across the nation, state-based health insurance exchanges are searching for ways to better serve their communities while making enrollment easier, more personal, and more accessible for everyone.
It’s Time to Rethink Prior Authorization for Chronic and Serious Conditions
Guideline directed care pathways are a way to shift from transactional PA, where each service requires separate approval, to an episode-of-care model.
Cohere Health Teams Up with Microsoft to Advance Prior Authorization Using Ambient Listening
Cohere Health and Microsoft have teamed up to use ambient listening and AI to simplify and speed up the prior authorization process, part of a broader industry shift toward reducing paperwork and improving care at the point of service.
Develop Health Secures $14.3M to Streamline Prior Authorization
Develop Health's Series A funding round was led by Wing Venture Capital, and included participation from Afore Capital, J Ventures and South Park Commons.
Highmark Health, Abridge Partner to Scale AI for Payers/Providers
Highmark Health recently announced a partnership with AI technology company Abridge to deploy its ambient clinical documentation platform across Allegheny Health Network and co-develop a new prior authorization solution.
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5 High-Impact Tax Strategies Every Physician Should Use in 2026 to Reduce Their Tax Bill
AI-native tax firm Gelt combines top human tax experts with AI to help physicians and healthcare practices use data-driven tax strategies to lower liabilities, improve profitability, and future-proof their finances.
Prior Authorization Reform Is Finally on the Table — Standards Must Be Too
It’s a meaningful step. But declarations alone won’t fix a system still powered by fax machines, phone calls, and inconsistent rules. Real progress will require a modern digital infrastructure, aligned incentives, and coordinated action across both the public and private sectors.
CMS and AHIP Isn’t the Finish Line: It’s the Starting Gun for Prior Auth Innovation
Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.
Physician-led AI: Unlocking Clinical Productivity In Prior Authorization
By keeping our AI and ML grounded in real-world medicine, we can shape a future where prior authorization works smarter, faster, and better for everyone involved.
Ochsner Health Scales AI Tool After Its Cuts Prior Authorization Time to Just 4-5 Minutes
Ochsner Health is expanding its use of Latent Health’s AI platform after its reduced medication prior authorization times to just 4-5 minutes. The technology is designed to both streamline pharmacists’ workflows as well as improve patients’ access to medications.
As Healthcare and Biopharma Companies Embrace AI, Insurance Underwriters See Risks and Opportunities
In an interview, Munich Re Specialty Senior Vice President Jim Craig talked about the risk that accompanies innovation and the important role that insurers play.
More Than 50 Health Plans Commit to Simplifying Prior Authorization
Several insurers, such as UnitedHealthcare, Aetna and Cigna, pledged to improve prior authorization. These changes include streamlining decision timelines and increasing transparency.
New Cohere Health Solution Aims to Streamline Clinical Reviews for Payers
Cohere Health introduced a new tool for payers called Review Assist. It is meant to support health plan clinical staff with prior authorization reviews and other use cases.
Managing Routine Radiology: An Opportunity to Control Costs and Improve Care
Managing routine radiology does not require the administrative burden of prior authorization. Instead, health plans can implement post-service, pre-payment automated management based on clinical guidelines.
Why One Leader Is Calling Out Insurers’ Inaction on Prior Authorization
The current prior authorization process in U.S. healthcare constitutes a crisis, according to Jesse Ehrenfeld, immediate past president of the American Medical Association. Prior authorization is wasting clinicians’ time, delaying care and deepening public distrust — yet, payers show little urgency in fixing this problem, he said.
What is Concurrent Review?
While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients.