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.
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UnitedHealthcare Expands Rural Healthcare Initiatives, Reduces Prior Auth Requirements
UnitedHealthcare is exempting rural providers from most prior authorization requirements.
The Hidden Administrative Tasks Draining Small Practices
Small practices play a critical role in healthcare delivery, but they cannot continue to absorb ever-increasing administrative demands without consequences.
Insurers have Cut Prior Auth by 11% Following Commitments
Health insurers have reduced prior authorizations by 11% and are continuing reforms to streamline and speed up approvals, according to an announcement from AHIP and Blue Cross Blue Shield Association.
Prior Authorization Is Broken. CMS’s New Rule Shows Why Regulated AI Is the Way Out
Technology alone won’t solve prior authorization. But refusing to adopt it guarantees the status quo: a system where insurers operate at machine speed, providers operate at human speed, and patients pay the price in delayed care.
Choosing the Right Methods for the Right AI to Accelerate Prior Authorizations
With regulatory scrutiny intensifying and the demand for speed, compliance, and clarity growing, understanding the nuanced differences between AI approaches is essential for payers, providers, and patients alike.
Payers Made a Bold Prior Auth Commitment in 2025. Here’s What to Expect in 2026
More than 50 major insurers have pledged to streamline prior authorization starting in 2026, but providers remain cautiously optimistic and skeptical that the changes will truly reduce burden or delays in care.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
Changes Are Coming to 2026 Medicare Benefits
Here are three things providers should consider when it comes to Medicare.
Test Your Healthcare Revenue Cycle Management Knowledge
Take our quiz and learn more about perspectives on AI and RCM in healthcare.
Vanderbilt CEO: Health Systems Can Fix Prior Auth Without Waiting for Payers
Health systems should take the lead in fixing the broken prior authorization process, said Jeff Balser, CEO of Vanderbilt University Medical Center, during a recent conference. He highlighted AI, better workflows and centralized support as ways to reduce delays.
Lawmakers Introduce Multiple Bills Aimed at Medicare Advantage Reform
Thirteen House Democrats introduced eight bills to rein in Medicare Advantage and bolster traditional Medicare.
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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.
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.
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.