A CMS pilot program will require providers in six states to submit select Medicare services for AI-enabled prior authorization or post-service medical review.

On Friday, the healthcare behemoth released results of three highly anticipated external reviews that drilled down on a ...

Anthony Taormina is an original member of the Game Rant team, having been part of the publication for 15 years. He coordinates content for all facets of the site and manages its social media, PR, and ...

While the headaches and life-altering results of insurance pre-authorizations are not new to physicians or patients, lately things have been getting worse. Patients are sending more and more messages ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Q: Do you have any suggestions on how to make the Utilization Review and Triple Check processes more efficient? A: Implementing a robust Utilization Review and Triple Check process serves several ...

Availity, the nation's largest real-time health information network, celebrates the news that the country's leading health insurers have pledged sweeping reforms to modernize the authorization process ...

JACKSONVILLE, Fla.--(BUSINESS WIRE)--Availity, the nation’s largest real-time health information network, celebrates the news that the country’s leading health insurers have pledged sweeping reforms ...

It’s no surprise that inappropriate care decisions can negatively impact patients, but they also place a strain on the entire health care system. At a time when the demand for health care providers ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...