As hospitals and health systems continue to grapple with revenue leakage and clinical denials, many are turning to innovative technologies to bridge the gap between payers and providers. Organizations ...

Utilization management involves methods by health care plan administrators to minimize costs while also maintaining the quality of care. The process is intended to prevent wasteful spending but not to ...

The MarketWatch News Department was not involved in the creation of this content. GenHealth.ai and Guidehealth achieved up to a 60% reduction in Utilization Management workload using GenHealth's ...

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 ...

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 ...

Findings of a survey of large employers indicate that utilization management tools are ineffective in controlling health care costs for employees and may lead to barriers to treatment. Employer ...

We appreciate the thoughtful response of Susan Cantrell and the Academy of Managed Care Pharmacy to our work (August 2021). Our study highlights the burden of drug utilization management on the ...

Imagine an altogether different kind of utilization management that both payers and providers appreciate, where approvals are made at the point of decision, not after the fact. Utilization management ...

Drug utilization management such as prior authorization and stricter formularies cost the healthcare industry $93 billion annually, with patients bearing the largest share of the cost, a new study ...

FRISCO, Texas--(BUSINESS WIRE)--Magellan Healthcare Inc., the behavioral healthcare segment of Magellan Health, Inc., today announced that it has earned full URAC accreditation for Health Utilization ...

Insurtech companies such as Oscar Health use technology to engage patients and offer risk-based, value-based care to engage providers in what is touted as a collaboration of savings, efficiency and ...