Payer Trends

Prior Authorization Process Improvements

2023-02-16T18:28:24-04:00By |Payer Trends, Trends, Utilization Management|

Prior authorization is a utilization management process used by some health insurance companies for determining if the patient’s health policy covers a prescribed services, like procedures, tests, or medications, before services are rendered. While intended to control healthcare costs, prior authorizations can be a significant burden on healthcare providers and can delay patient care.

Top At-Risk Conditions and Utilization Spikes

2023-01-12T11:12:16-04:00By |Behavioral Health Integration, Mental Health, Payer Trends, Quality Improvement Programs, Revenue Cycle Improvement, Trends, Utilization Management|

Top At-Risk Conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year highlight the recently released, 2023 State of Health – In The Aftermath Report. The report also presents predictive findings and explores the top contributing factors of many utilization increases.

Healthcare Independent Review and ‘No Surprise Act’

2022-10-19T14:51:08-04:00By |Healthcare Independent Review, IRO, Payer Trends|

Understanding the Vital Role, Challenges, and Opportunities of Independent Medical Review Services, offers a behind-the-scenes look at internal and external appeals, reasons why accredited IROs reduce risks, and a crash course on newer review services, such as the independent dispute resolution process that’s part of the No Surprise Act (NSA) surprise billing regulations.

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