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Prior Authorization Topic Center

The Latest

Commentary
Enhancing Provider Experience Through Electronic Prior Authorization
08/13/2024
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical...
08/13/2024
First Report Managed Care
Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Dr Brian Covino
Interview
Green Lighting Solutions to Address Barriers in Health Care Prior Authorizations
03/05/2024
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to...
03/05/2024
First Report Managed Care

Newsfeed

Commentary
Enhancing Provider Experience Through Electronic Prior Authorization
08/13/2024
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical Association (AMA) surveys its membership to ascertain their feedback concerning prior authorizations (PAs) and the impact of this service on their practice. Reliably, AMA members say that PAs are disruptive to...
Each year the American Medical...
08/13/2024
First Report Managed Care
Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Dr Brian Covino
Interview
Green Lighting Solutions to Address Barriers in Health Care Prior Authorizations
03/05/2024
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to...
03/05/2024
First Report Managed Care
Headshots
Commentary
How to Maximize the Value of GLP-1 Drugs While Improving Health Equity
01/14/2025
GLP-1 drugs present significant financial and health equity challenges, offering transformative benefits for obesity and cardiometabolic disorders while requiring data-driven strategies for cost-effective and equitable access.
GLP-1 drugs present significant financial and health equity challenges, offering transformative benefits for obesity and cardiometabolic disorders while requiring data-driven strategies for cost-effective and equitable access.
GLP-1 drugs present significant...
01/14/2025
First Report Managed Care
News
Patient-Reported Outcomes Drive Value-Based Care in Multiple Sclerosis
01/13/2025
A recent study published in Journal of Managed Care & Specialty Pharmacy explored multiple sclerosis (MS) as a compelling therapeutic area for outcomes-based agreements (OBAs) by assessing the use of patient-reported disability progression to...
A recent study published in Journal of Managed Care & Specialty Pharmacy explored multiple sclerosis (MS) as a compelling therapeutic area for outcomes-based agreements (OBAs) by assessing the use of patient-reported disability progression to...
A recent study published in...
01/13/2025
First Report Managed Care
News
Study Highlights the Substantial Economic and Health Care Burden of Vitiligo
01/13/2025
Patients with vitiligo in the US face significantly higher health care costs and resource utilization compared with the general population, according to a study published in the Journal of Investigative Dermatology.
Patients with vitiligo in the US face significantly higher health care costs and resource utilization compared with the general population, according to a study published in the Journal of Investigative Dermatology.
Patients with vitiligo in the US...
01/13/2025
First Report Managed Care
News
Biosimilars Expand Access and Cut Costs in HER2-Positive Cancer Treatment
01/10/2025
Biosimilar versions of trastuzumab have rapidly gained market share in treating HER2-positive breast cancer since their introduction to the US markets.
Biosimilar versions of trastuzumab have rapidly gained market share in treating HER2-positive breast cancer since their introduction to the US markets.
Biosimilar versions of...
01/10/2025
First Report Managed Care
News
COVID-19 Infection Linked to Increased Risk of Skin Conditions
01/08/2025
A recent study found that COVID-19 infection significantly increases the risk of developing skin conditions such as vitiligo, chronic urticaria, alopecia areata, and herpes zoster.
A recent study found that COVID-19 infection significantly increases the risk of developing skin conditions such as vitiligo, chronic urticaria, alopecia areata, and herpes zoster.
A recent study found that...
01/08/2025
First Report Managed Care
Formoso Headshot
Videos
Minimally Invasive Solutions for Lumbar Disc Herniation
01/07/2025
In this interview, Ferdinand Formoso, DO, discusses the role of condoliase as a minimally invasive treatment for lumbar disc herniation, its safety profile, potential areas for further research, and its ability to address unmet needs in spine...
In this interview, Ferdinand Formoso, DO, discusses the role of condoliase as a minimally invasive treatment for lumbar disc herniation, its safety profile, potential areas for further research, and its ability to address unmet needs in spine...
In this interview, Ferdinand...
01/07/2025
First Report Managed Care
News
Provider Perceptions of Biosimilar Use in Oncology Networks
01/03/2025
Research published in the Journal of the American Pharmacists Association examined provider perceptions of barriers to biosimilar use in a large oncology network, revealing low levels of perceived barriers and high utilization rates, with...
Research published in the Journal of the American Pharmacists Association examined provider perceptions of barriers to biosimilar use in a large oncology network, revealing low levels of perceived barriers and high utilization rates, with...
Research published in the...
01/03/2025
First Report Managed Care
DeMarrais Headshot
Commentary
How Health Systems Can Meet the Expanding Needs of Specialty Pharmacies
01/03/2025
Health systems must adapt to the growing demand for specialty pharmacies by scaling services, embracing technology, and collaborating with experts to improve patient outcomes, reduce administrative burdens, and navigate regulatory challenges.
Health systems must adapt to the growing demand for specialty pharmacies by scaling services, embracing technology, and collaborating with experts to improve patient outcomes, reduce administrative burdens, and navigate regulatory challenges.
Health systems must adapt to the...
01/03/2025
First Report Managed Care
Varshney Headshot
Interview
Transforming Drug Development Through Real-World Evidence and Artificial Intelligence
01/03/2025
In this interview, Dr Jo Varshney, founder and CEO of VeriSIM Life, discusses the complexities of drug development, the role of AI in accelerating discovery, the integration of real-world evidence, and strategies to reduce costs while...
In this interview, Dr Jo Varshney, founder and CEO of VeriSIM Life, discusses the complexities of drug development, the role of AI in accelerating discovery, the integration of real-world evidence, and strategies to reduce costs while...
In this interview, Dr Jo...
01/03/2025
First Report Managed Care
KOL Headshots
Commentary
2024 Trends and 2025 Predictions: Insights From Health Care Leaders on Advancing Medicare, AI Solutions, and Clinical Data Utilization
12/27/2024
In this exclusive commentary for First Report Managed Care, health experts and business leaders explore how advancements in Medicare Advantage, ambient intelligence, generative AI, cybersecurity, risk adjustment, precision oncology, and AI...
In this exclusive commentary for First Report Managed Care, health experts and business leaders explore how advancements in Medicare Advantage, ambient intelligence, generative AI, cybersecurity, risk adjustment, precision oncology, and AI...
In this exclusive commentary for...
12/27/2024
First Report Managed Care

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