Big changes are coming to prior authorization in 2026, with CMS mandating faster, fully electronic processes for Medicare Advantage, Medicaid, CHIP, and ACA plans. Providers will need to adopt ...

As 2026 progresses, the ePA ecosystem is undergoing a significant transformation driven by two major developments: CoverMyMeds has launched an industry-first integrated medication access experience, ...

Prior authorization (PA) was introduced as a patient safety mechanism, a check to ensure that the right medications are prescribed for the right patients at the right cost. Over time, that safety ...

Individual plans will also commit to specific medical prior authorization reductions, as appropriate for each plan's local market, with demonstrable results by Jan. 1, 2026. According to AHIP, by 2027 ...

KANSAS CITY, MO, UNITED STATES, January 27, 2026 /EINPresswire.com/ — Onyx, the leading healthcare interoperability platform provider and 2025 Best in KLAS ® for ...

BOSTON, MA / ACCESS Newswire / May 29, 2025 / 1upHealth, a leader in health data interoperability, today announced the launch of its 1up Prior Authorization solution. The solution is designed to ...

Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access PARSIPPANY, N.J., Feb. 19, 2025 /PRNewswire/ -- Agadia, a leader in Utilization Management ...

Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. This voice experience is generated by AI. Learn more. This voice ...

A reproducible Prior Authorization Friction Index enables payers to identify glucagon-like peptide-1 delays and rework, reduce avoidable barriers, and monitor utilization, budgets, and equity in ...

The proposed rule on interoperability standards and prior authorization could lead to significant change in CMS. Prior authorization has become one of the clearest points where administrative ...

For years, hospital billing has proven to be one of the most challenging and costly operational burdens for healthcare facilities. Medical claims that should receive payment often require extended ...