Prior Authorization Determination
Prior Authorization Targeted by CMS Medicare
Under the guise of fraud and waste prevention, the Centers for Medicare & Medicaid Service (CMS),along with dozens of large healthcare insurance companies, have revealed forthcoming changes to the “Prior Authorization” process. Prior Authorization is a process used by various…
Medicare Advantage insurers and prior authorization determinations in 2023
Medicare Advantage members, 99 percent, are required to obtain prior authorization for higher-cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. Insurers will use prior authorization and provider networks to manage utilization and lower costs. The…