Skip to Content

Tag: Prior Authorization


Also Noted

Parachute Health embeds authorization process

June 18, 2024HME News Staff

NEW YORK – Parachute Health has launched a partnership with Optum and Walgreens/CareCentrix to embed prior authorization workflows directly into the prescribing process, liberating providers from what’s typically a back-and-forth process. “I am excited to be streamlining the ordering and authorization process by partnering with payers and building the necessary cost-controls to eliminate the current administrative burden that all stakeholders face," said David Gelbard, CEO...

CareCentrix, Optum, Parachute Health, Prior Authorization, Walgreens


Read Full Articlered right arrow icon

Also Noted

Lawmakers reintroduce prior auth bill 

June 13, 2024HME News Staff

CHICAGO – Members of the House of Representatives and Senate have reintroduced bipartisan legislation to streamline and standardize the use of prior authorization within Medicare Advantage. The Improving Seniors’ Timely Access to Care Act, which has the support of the American Medical Association, features targeted policy changes to reduce the scored cost of the legislation, an obstacle last Congress. “We thank the sponsors for writing the bill so it will attract even more support,”...

Medicare Advantage, Prior Authorization


Read Full Articlered right arrow icon

Also Noted

AMA seeks greater oversight of MA plans

June 11, 2024HME News Staff

CHICAGO – Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates approved policies to address the need for greater oversight of health insurers’ use of prior authorization controls on patient access to care. The new policies address insurer accountability and transparency for PA denials. “Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health,” said AMA...

American Medical Association (AMA), Prior Authorization


Read Full Articlered right arrow icon

David Chandler

News

CMS piles on prior auth requirements 

February 7, 2024Liz Beaulieu, Editor

YARMOUTH, Maine – A rule finalized in January is CMS’s latest bid to fine-tune the prior authorization process for Medicare Advantage plans and other payers to increase efficiency and transparency.  The agency in January finalized a rule requiring MA plans and other payers like Medicaid and Medicaid managed care to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. For some payers, CMS says, this cuts the current...

Andrea Stark, David Chandler, Medicare Advantage, Prior Authorization


Read Full Articlered right arrow icon

News

In brief: Prior auth burden, VGM Forbin president, JANZ acquisition

January 19, 2024HME News Staff

WASHINGTON – CMS has finalized a rule that sets requirements for Medicare Advantage organizations and other programs to improve the electronic exchange of health information and prior authorization processes and reduce burden on patients, providers and payers.  The agency estimates its Interoperability and Prior Authorization Final Rule (CMS-0057-F) will result in $15 billion in estimated savings over 10 years.  “When a doctor says a patient needs a procedure, it is essential...

Complex Rehab Technology (CRT), JANZ, Masimo, Mullaney's Medical Supply, Prior Authorization, United Spinal Association, VGM Forbin


Read Full Articlered right arrow icon

News

CMS expects big savings from prior auth rule

January 18, 2024HME News Staff

WASHINGTON – CMS has finalized a rule that sets requirements for Medicare Advantage organizations and other programs to improve the electronic exchange of health information and prior authorization processes and reduce burden on patients, providers and payers.  The agency estimates its Interoperability and Prior Authorization Final Rule (CMS-0057-F) will result in $15 billion in estimated savings over 10 years.  “When a doctor says a patient needs a procedure, it is essential...

DME Medicare Administrative Contractor (DME MAC), Prior Authorization


Read Full Articlered right arrow icon

newspoll

News

Slight majority opposes prior auths, according to poll

September 15, 2023Theresa Flaherty, Managing Editor

YARMOUTH, Maine – Prior authorizations have their uses, but they also create a heavy burden with no guarantee of payment, say 58% of respondents to a recent HME Newspoll.  “Prior authorization is fine if the insurance plan honors their end of the agreement,” wrote one respondent. “To do all the work to obtain the PA only to receive a denial is very frustrating. Even more frustrating is to have the plan tell you that prior authorization is not a guarantee of payment.”  Prior...

Prior Authorization


Read Full Articlered right arrow icon

On the Editor's Desk

Swords and sticks

September 15, 2023Liz Beaulieu, Editor

YARMOUTH, Maine – It was big news when UnitedHealthcare announced it would reduce the number of product codes requiring prior authorizations. Cigna soon followed suit and then Blue Cross Blue Shield of Michigan and others. While it was big news, it wasn’t surprising.  The American Medical Association (AMA) has been on a fierce campaign to reduce prior authorizations. On its website, the AMA characterizes it this way: “Prior authorization is a health plan cost-control process...

Prior Authorization


Read Full Articlered right arrow icon

Also Noted

Cigna updates prior auths list

September 7, 2023HME News Staff

BLOOMFIELD, Conn. – Cigna has removed prior authorization requirements for nearly 25% of medical services. With the removal of these 600-plus codes, the insurer has now removed prior authorization requirements on more than 1,100 medical services since 2020. "Our goal is to help keep patients safe, improve health outcomes, and make care more affordable, and this important step will enable us to do that while removing administrative burdens on the health care system," said David Brailer, MD,...

Cigna, Prior Authorization


Read Full Articlered right arrow icon

Laura Williard

News

Stakeholders seek details on UHC plan to eliminate some prior auths

September 1, 2023Theresa Flaherty, Managing Editor

WASHINGTON – UnitedHealthcare’s plan to reduce prior authorizations was met with skepticism by industry stakeholders who say it’s more likely a public relations move in response to increased government scrutiny.  In August, UnitedHealthcare said it would begin a two-phased approach to eliminating prior authorizations for many product codes starting Sept. 1, 2023. That’s after the Senate Homeland Security and Government Affairs Committee in May held a hearing on...

AAHomecare, Prior Authorization, UnitedHealthcare, VGM & Associates


Read Full Articlered right arrow icon