Prior Authorization Insights

June 21, 2026 · 5 min read

What an Overturned Denial Is Actually Measuring

An overturned prior authorization denial is not a single operational event. It can reflect new documentation, a different interpretation, or external review, but those pathways disappear once the outcome becomes a reported rate.

June 14, 2026 · 6 min read

Prior Authorization Requirements and Workflow Clarity: Two Separate Problems

Publishing prior authorization requirements and creating operational clarity around those requirements are separate problems. The denial itself often does not explain what actually needs to change before resubmission.

June 7, 2026 · 5 min read

The Denial Rate Has a Resolution Problem

Prior authorization denial rates are reported as a single outcome category. The operational pathways producing those denials are not reported at all.

May 31, 2026 · 6 min read

Before the Decision and After It: The Hidden Labor Cost of Prior Authorization

Across interviews with utilization management and hospital operations professionals, a recurring pattern emerged: prior authorization metrics capture outcomes, while the operational burden surrounding those outcomes remains completely invisible.

May 17, 2026 · 6 min read

UnitedHealthcare Is Cutting Prior Auth for 30% of Services. Here's What That Actually Covers.

UnitedHealthcare's 30% prior authorization reduction sounds broad, but the impact depends on the denominator: prior authorization applies to about 2% of its medical services. This analysis looks at what the announcement changes, what it does not, and why service-level reporting matters.

May 10, 2026 · 8 min read

Prior Auth Transparency Is Live. Most of It Isn't Usable.

Original analysis from 1,300+ health plan entries on what is actually missing from the first year of CMS prior authorization transparency reporting.