Prior authorization guides

Why was my prior authorization denied? Top reasons and how to fix each

The most common reasons prior authorizations get denied, and the specific fix for each: documentation gaps, unmet medical-necessity criteria, coding issues, conservative-care history, and administrative errors.

How to write a prior authorization appeal that cites policy

A step-by-step structure for prior authorization appeals that win on policy, not sympathy: identify the exact criteria, map documentation to each, cite evidence, and address the denial reason directly.

CMS 2027 prior authorization rule: what providers need to know

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F): electronic prior-authorization APIs, shorter decision timeframes, required denial reasons, and the January 1, 2027 effective date for the API requirements.

Prior authorization peer-to-peer review: how to prepare

How to prepare for a prior authorization peer-to-peer review: know the exact denial reason and policy criteria, have the chart and imaging ready, and present a concise clinical narrative mapped to the criteria.

Gold-card prior authorization laws: what they are and which states have them

Gold-carding exempts providers with a strong prior-authorization approval history from having to get prior authorization for qualifying services. How it works, what it requires, and how to find your state law.

Should a small practice pilot an AI prior authorization tool? How to decide

A practical framework for specialty practices weighing an AI prior authorization tool: what to evaluate, how a low-risk pilot de-risks the decision, what a good pilot looks like, and how to start without an EHR project.