Prior authorization has been a bone of contention between payers and providers for some time now. Payers argue that it helps avoid unnecessary care and reduces costs, while providers say it creates ...
Major health insurance providers have agreed to reduce the need for prior authorization — the requirement that patients must get approval from insurers before receiving certain treatments or risk ...
The bill would establish a standardized electronic prior authorization process for Medicare Advantage plans, and it could serve as a model for new rules for employer plans. U.S. Senate Chamber. Photo: ...
Q2 Are there best practices for translating medical policies governing prior authorization into machine-readable language? Prioritize the 80/20s to pull forward your plan’s ROI. Translating all ...
A six-state pilot program will target “wasteful care” under Medicare, Centers for Medicare & Medicaid Services says.
Forbes contributors publish independent expert analyses and insights. Jesse Pines is an expert in healthcare innovation and wellness. Health insurer prior authorization has increased considerably in ...
InterSystems begins with four sets of three related considerations when working with IT leaders at health plans to maximize ROI on new prior authorization (PA) APIs required by CMS-0057-F. The first ...
Health Care Service Corp., a health plan operator for 18 million members across Illinois, Montana, New Mexico, Oklahoma and Texas, is integrating artificial intelligence and augmented intelligence to ...
Health plan leaders uphold responsible guardrails that enable affordable and quality care. However, with the rising cost of healthcare in the United States, this can be challenging. Two essential ...
Develop Health, a benefits verification and prior authorization platform, has raised $14.3 million in Series A funding, the company announced on Wednesday. The San Francisco-based company’s platform ...
Ahead of HIMSS26, Sairohith Thummarakoti of Texas A&M University–Kingsville previews his talk on how agentic AI and low-code ...
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