Prior Authorization

The subject of prior authorization encompasses a wide range of important elements. What is prior authorization? - American Medical Association. Prior authorization is a health plan cost-control process that requires physicians and other health care professionals to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. Prior authorization | American Medical Association.

It is overused, costly, inefficient, opaque and responsible for patient care delays. What doctors wish patients knew about prior authorization. The AMA’s What Doctors Wish Patients Knew ™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

In this installment, Jack Resneck Jr., MD, a dermatologist and immediate past president of the AMA, discusses what patients need to know about prior authorization and the pivotal role they can play in fixing it. Additionally, don’t fall for these myths on prior authorization. Prior Authorization Don’t fall for these myths on prior authorization Behemoth health insurers claim this time-wasting practice improves care and saves everyone money.

It's important to note that, look beyond the myths and find out the facts. Prior authorization practice resources - American Medical Association. Furthermore, prior authorization—sometimes called preauthorization or precertification—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage. Inside payers' latest plans to streamline prior authorization.

AMA News Wire Inside payers' latest plans to streamline prior authorization Jul 14, 2025 With state and federal policymakers eyeing restrictions on health insurers’ use of the care-delaying cost-control process of prior authorization, the nation’s biggest carriers are pledging anew to make changes on a voluntary basis. Similarly, fixing prior auth: Clear up what’s required and when. This perspective suggests that, prior authorization is a multifaceted problem that needs to be tackled from numerous angles. High on the hit list are the sluggish response times, an overwhelming and increasing volume of requirements, inadequate peer-to-peer reviews and more.

Building on this, prior authorization reform initiatives - American Medical Association. Prior authorization reform principles An AMA-convened workgroup of 17 state and specialty medical societies, national provider associations and patient representatives developed best practices for prior authorization and other utilization management requirements by identifying the most common provider and patient concerns. How AI is leading to more prior authorization denials. Over 60% of doctors say unregulated AI tools systematically deny patients coverage for necessary care. The AMA is fighting to fix prior authorization.

How the AMA fights for patients, doctors on prior authorization. It's important to note that, work with interested organizations in the development and publication of public and private plan scorecards related to prior authorization approvals, denials, appeals and the time frames for responding to requests for authorization and processing physician payments to better inform patients, physicians and purchasers of insurance.