A Four-Part Roadmap for Responsible Prior Authorization
The tools exist today to significantly reduce PA's burden on our healthcare system, we just need to mobilize and implement them.
Cohere Health Snags $90M to Automate the Much-Maligned Prior Authorization Process
Cohere Health raked in $90 million in Series C capital, taking its total funding to date to $200 million. This round of funding cements Cohere as the emerging winner in the prior authorization tech category, according to Michael Greeley, general partner at Flare Capital Partners.
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The Top Surgical Instruments Needed for Extractions
Discover what tools are essential for efficient, safe surgical extractions in today’s health care landscape, from elevators to forceps and beyond.
Gold Carding Programs Are Meant to Improve Prior Authorization. Are They Working?
Several states and insurers have gold carding programs to streamline prior authorization. However, some say they're falling short.
How Health Plans Are Adding Up Real Value From AI
AI tools can work together across the payer value chain, exchanging information, collaborating and making autonomous decisions based on business rules. Here are just a few examples of how their bottom lines are benefiting.
Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care
With these tools, therapists can reclaim their time, focus on their patients, and deliver the high-quality care that every individual deserves — all while maintaining the financial stability to thrive in their practices.
Video: What Would Happen If Prior Authorization Went Away?
Prior authorization is a sore subject for payers and providers. So what if it went away? In a recent fireside chat hosted by MedCity News, Don Antonucci, CEO of Providence Health Plan, shared his thoughts.
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5 Major Trends Emerging in Healthcare Benefits in 2025
Employees who enjoy their benefits are more inclined to stay with their company. A 2025 Marsh McLennan Agency report said 73% of employees would remain if plan options were better.
Blue Shield of California, Salesforce Partner to Modernize Prior Authorization
During HLTH 2024, Blue Shield of California and Salesforce announced a partnership that will streamline the prior authorization process.
Navigating the Government’s Medicare Advantage Prior Authorization Changes
The reintroduction of the "Improving Seniors' Timely Access to Care Act" marks a critical step toward modernizing the prior authorization process within Medicare Advantage plans. So, what does this mean for patients and providers moving forward?
Report: MA Insurers Denied 3.4M Prior Authorization Requests in 2022
About 7.4% of prior authorization requests submitted to MA insurers were denied in 2022, according to a recent KFF report. Of these denials, only 9.9% were appealed.
Putting Payers in the Driver’s Seat: How the New CMS Interoperability and Prior Authorization is Changing Healthcare
As the industry embarks on this fundamental transformation, a few key questions must be answered.
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The Top-Rated Orthopedic Surgery Centers in the Houston Area and Beyond
Discover Houston's best orthopedic surgery centers and what features — from personalized treatment plans to rehabilitation services — make these top providers stand out in their industry.
Insurer “Delay and Deny” Practices Continue to Threaten Patients’ Timely Access to Gastrointestinal Care – It’s Time for Reform
Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.
Seven Trends to Watch in Healthtech AI
As the role of AI in healthcare settings continues to evolve and generate debate, here are seven things to keep an eye on.
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Is AI in Prior Authorization Promising or Dangerous?
AI can improve the prior authorization process, but there needs to be more transparency, experts said during a recent panel held by KFF.
CMS Finalizes Rule Streamlining Prior Authorization Process
CMS finalized a rule on Wednesday that included set deadlines for affected payers to complete prior authorization requests. Several organizations came out in support of the rule.