Forbes contributors publish independent expert analyses and insights. Diane Omdahl is a Medicare expert who keeps her readers in the know. Over the last several years, prior authorization has become a ...

High rates of prior authorization denials and limited state oversight suggest some Medicaid managed care beneficiaries aren’t able to access necessary medical care, according to a recent report by the ...

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.

There’s a key question more providers need to know the answer to: What is a contract exclusion? A contract exclusion details the medications and treatments that are not included in the levels of a ...