#prior-authorization

#prior-authorization

Government-backed plans like Medicare, however, have tended to cover what private insurers don't, and without the laborious application process. But that could be poised to change. The Centers for Medicare and Medicaid Services said it'll experiment with its own version of prior authorization by using AI models to screen claims, as part of its new belt-tightening program called the Wasteful and Inappropriate Service Reduction model, or WISeR.

The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike, according to AHIP CEO Mike Tuffin.