The case of one Maine woman shows how prior authorization rules can block coverage for even simple, medically necessary care.

SAN FRANCISCO, Nov. 20, 2025 /PRNewswire/ -- SamaCare, the leading prior authorization platform for specialty practices, today announced the launch of SamaCare Plus, a next-generation AI offering that ...

The AI-powered prior auth requirements under the CMS' Wasteful and Inappropriate Service Reduction model would increase ...

The WISeR model – intended to reduce spending on seniors in traditional Medicare through Wasteful and Inappropriate Service Reduction – will require prior authorization in traditional Medicare for a ...

The aggravating prior authorization process includes one step that merits scrutiny and potentially regulatory action: the peer-to-peer review.

None of the initial treatments prescribed by his doctors had eradicated the cancer. But a glimmer of hope came in early 2025, when Tennant was recommended for histotripsy, a relatively new procedure ...

We aim to provide transparency in how Elevance Health plans address variations in clinical practices to ensure safe, ...

UnitedHealthcare is fully committed to supporting its members by providing access to advanced assistive technology, as ...

While the AHA has called on CMS to rethink its plan to add prior authorization requirements to traditional Medicare, some argue that the program is due for some utilization management.