The Centers for Medicare & Medicaid Services released a proposed rule Oct. 16 seeking to codify regulations that will improve the accuracy of Medicare Advantage plan provider directories, establish transparency and compensation requirements for pharmacy benefit managers and their affiliates, and reduce…
HIT Consultant What You Should Know - Humana and athenahealth announced a nationwide expansion of integrated electronic prior authorization (ePA) capabilities across athenahealth’s network of more than 180,000 physicians and clinicians. - The collaboration directly addresses administrative friction in provider workflows, replacing manual…
Five large employers, Amazon, Axon Enterprise, Google, Meta, and Oracle, have signed a federal statement supporting electronic prior authorization for workers covered by self-funded health plans. The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services,…
Starting Dec. 1, UnitedHealthcare will stop requiring prior authorization for more than 2,000 medical service codes for members under age 18, the insurer announced in a news release on Nov. 2. The list includes MRI and CT scans, sleep studies, ear tube and tonsil…
For the world’s wealthy, health and wellness has become an increasingly major focus, with many spending large amounts of money on preventative healthcare, investing in longevity and splurging on appearance enhancing treatments and surgeries designed to keep them looking and…
November 3, 2026 by Laurie Watanabe Is the expansion of Medicare prior authorization actually good news for durable medical equipment (DME) suppliers? The Centers for Medicare & Medicaid Services (CMS) has described prior authorization as a tool to reduce DME fraud, waste and…
Medicare is changing how much it pays dialysis facilities in 2027, with new rules affecting treatment reimbursements, medications, and quality standards for Americans living with kidney failure. The Centers for Medicare & Medicaid Services (CMS) announced that its updated dialysis payment rate…
The first study of traditional Medicare’s prior-authorization pilot program finds reduced service use, but cannot determine whether the care forgone was needed or unnecessary. The study, published in JAMA, found: “As a physician, I know how burdensome prior authorization can…
For European health systems, fairness is consequently a practical design and evaluation problem. It involves the outcome a model is trained to predict, the people represented in its evidence and the way clinicians and patients respond to it. Research is…
Today, the Center for Health & Democracy Education Fund (CHDEF) released a new white paper, Artificial Intelligence in Health Care: Spotlight on Health Insurers, examining what we know and, perhaps more importantly, what we don’t know about the growing use of…
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