Insights shaping the future of prior authorization, utilization management, and healthcare technology.
Explore expert perspectives, industry trends, product innovations, interoperability developments, AI advancements, and operational best practices from the teams helping modernize healthcare workflows across Health Plans, PBMs, and healthcare organizations.
How AI is reshaping prior authorization workflows.
Learn how AI-powered automation, OCR, NLP, and intelligent clinical review capabilities are helping organizations reduce manual work and improve operational efficiency.
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Regulatory Readiness: How Case Work Automation Strengthens Oversight & Auditing
In healthcare, regulatory oversight is constant. Organizations must demonstrate that grievance cases are resolved within mandated timelines, tracked appropriately, and documented with accuracy. The Centers for Medicare & Medicaid Services (CMS), for example,...
Tackling GLP-1 Medication Growth with Smarter Prior Authorization Strategies
GLP-1 medications are creating new challenges for health plans due to rising demand and costs. Originally developed for type 2 diabetes, these drugs are now widely prescribed for weight management, sleep apnea, and other clinical uses. As this surge continues,...
Streamlining Prior Authorization: The Role of Interoperability, Automation and AI in Improving Efficiency and Patient Care
The healthcare industry is facing unprecedented challenges in streamlining prior authorization (PA) processes effectively. According to a report by the Arthritis Foundation, the average wait time for medical procedure PAs ranges from a few days to several weeks,...
The Impact of Prior Authorization on Patient Care: Pros and Cons
Prior authorization (PA) is a process used by health insurance companies to determine whether certain medications, procedures, or treatments are medically necessary before approving coverage. While the goal is to control costs and prevent unnecessary treatments, PA...
The Future of Grievance Management: Trends & Innovations
In today’s rapidly advancing healthcare industry, managing grievances has become more complex than ever. With rising regulatory scrutiny, evolving patient expectations, and a growing demand for efficiency, health plans and pharmacy benefit managers (PBMs) need...
Press Release: Agadia Expands Market Reach with a New ePA Portal for Specialty Drugs
Agadia Expands Market Reach with a ePA Portal for Specialty Drugs Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access Agadia is proud to announce the expansion of its electronic prior authorization (ePA)...
Preparing for the CMS Interoperability and Prior Authorization Final Rule
Last year, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), a significant step toward improving healthcare efficiency, enhancing patient access to care, and reducing...
What is Prior Authorization and Why is it Important?
One of the most common and often misunderstood components of insurance plans is prior authorization (PA). While it might seem like an extra hurdle, PA plays a significant role in healthcare cost management and patient safety. Key Takeaways: Prior authorization ensures...
Navigating the Evolving CMS Medication Therapy Management Landscape in 2025
The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver...
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024
The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in healthcare: the inefficiencies of prior authorization. With broad support in both the House and Senate, this...