Authorizations

The prior authorization (PA) process has become an essential yet challenging aspect of patient care. It’s a task that requires meticulous attention to detail. It takes a deep understanding [...]

Why Are Ophthalmologists Still Faxing Prior Authorizations? Key Takeaways Ophthalmology’s largest authorization category, anti-VEGF drugs, sits outside the CMS-0057-F decision timeframes for now. [...]

Why Are Orthopedic Practices Still Faxing Prior Authorizations in the ePA Era? Key Takeaways Fully electronic prior authorization reached 40% in the 2025 CAQH Index, while electronic attachment [...]

Editor’s Update, July 2026 Tandem AI has rebranded as Forus. The name change follows a $160 million funding round that valued the company at $1 billion. The medication prior authorization [...]

Prior authorization is supposed to work like a checkpoint. In most practices, it works more like a chokepoint. In the AMA’s 2025 Prior Authorization Physician Survey, 95 percent of [...]

How Insurer Prior Authorization Requirements Create Revenue Cycle Bottlenecks Prior authorization used to be a staffing decision. Now it’s a revenue decision. The volume of authorization [...]

Outsourcing prior authorization used to be a staffing decision. Now, well, it’s a revenue decision. Denials are rising faster than volume, more remote practices are seeing their reimbursements [...]

The vendor pitch sounds clean. The data tells a different story. If you run a practice, a health system, or a specialty group, you’ve probably heard the pitch. An AI vendor says it [...]

Prior authorization isn’t getting simpler. Despite years of reform promises, the 2024 AMA Annual Survey found that physicians now complete an average of 39 prior authorizations per week, [...]

When a claim comes back denied, the instinct is usually the same: send it to billing, figure out what went wrong, and resubmit. That workflow might feel like a system, but for many practices it [...]