A medical professional explains the many facets of the prior authorizations process for drugs in women’s health. Ryan Haumschild, PharmD, MBA, MS: Prior authorizations are something that we’re used to ...

Neil Minkoff, MD: Dr Stephens, could you also weigh in on how utilization management is looked at for glaucoma therapies or agents? Kevin Stephens, Sr., MD: The big thing here is that with this ...

Utilization management has the power to perform many jobs. Will it? Well before the Affordable Care Act, CMS defined the highest aim of utilization management: Value. In its 1991 UM study, the agency ...

Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

Although the literature has investigated utilization management practices, how they align with clinical practice guidelines is not well understood. 10, 11 A better understanding of this alignment ...

The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage Utilization Management Annual Data Submission ...

Peoria, Ill.-based OSF HealthCare will use an AI-based and machine learning platform to streamline its utilization management services and improve workflows. The new platform, dubbed CORTEX, will help ...

WINTERVILLE, N.C.--(BUSINESS WIRE)--NantHealth, Inc. (NASDAQ-GS: NH), proudly announces that its Utilization Management Program has earned a 3-year reaccreditation from the National Committee for ...

NEW YORK--(BUSINESS WIRE)--Today, VirtualHealth announced the release of a completely redesigned Utilization Management (UM) module within its cloud-based care management solution HELIOS®. The newly ...

Insurance companies often restrict University of Utah Health physicians from prescribing the optimal drug for a patient's illness. Providers are left to choose between the second or third choice after ...