Medicare providers participating in and payers offering Part C and Part D plans are facing increasing pressure to move into the 21st century, and the government is taking decisive steps to ensure this ...

When you are sick or in pain, the prior authorization process can be frustrating and will sometimes result in a denial. If you've never been through the process, prior authorization is a requirement ...

Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare for original Medicare. That distinction changes in 2026. Many ...

When you join a Medicare Advantage plan, your care sometimes requires an extra step before treatment begins. This process is called prior authorization, and it helps your insurance plan confirm that a ...

Berwick is a former administrator of the Centers for Medicare and Medicaid Services. He is a senior fellow for health policy and Ducas is the VP of health policy at the Center for American Progress.

A Medicare pilot program will allow private companies to use artificial intelligence to review older Americans' requests for ...

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.