Prior authorization is the process through which a doctor seeks approval from a person’s health insurance plan before ordering a specific medication or medical service. Original Medicare (parts ...

The stated objectives of prior authorization (PA) are to reduce unnecessary care and costs. However, as a 2022 Department of ...

CMS Rule 0057 requires health plans to develop and support FHIR-based APIs to enable electronic prior authorization (ePA). Whether return on this investment stops at ...