Medicare Advantage growth aggravates prior authorization burdens in several ways. Most medical groups, providing care to patients with Medicare Advantage plans, must comply with more prior authorization requirements.
Adverse Determination Appeals will have various impacts on patient care, depending on the specific circumstances and the nature of the determination.
Payviders offer both insurance coverage and healthcare services to patients. This concept is a relatively new development in the healthcare industry, and it has the potential to significantly impact the way that healthcare is delivered and financed.
Prior Authorization AI and the Future - The process of prior authorization can be time-consuming and complicated for healthcare providers.
Intelligent Document Processing (IDP) is a technology that uses artificial intelligence (AI) and machine learning to automatically extract and process data from documents such as claims forms, invoices, and medical records. This eliminates the need for manual data entry and speeds up the processing of claims and other documents.
AI Practices: Healthcare payers, such as insurance companies and government agencies, are increasingly turning to artificial intelligence (AI) to improve their operations and provide better services to their members.
Over the last few years, there has been a rapid switch in organizations allowing and encouraging Work From Home (WFH) options. This switch has occurred at an unprecedented pace and much about this change on such a large scale is still unexplored. While BHM has always had a very strong background in data analytics and reporting, we took this opportunity to explore ethical and fair productivity metrics to allow for data-driven decision-making around our WFH practices.
Many of your most challenging claims and cases likely present a behavioral health component. Due to the behavioral healthcare shortages described in this blog, BHM offers a reviewer network with the most sub-specialties. 6 of the top 10 largest health plans entrust BHM for peer reviews. CLICK HERE to learn more about how BHM helps your organization curb behavioral health costs.
Telehealth continues to grow rapidly in both availability and popularity for members with behavioral healthcare needs. The use of telehealth grew 624% from 2014 to 2018, according to a new study from FAIR Health.
Private insurance claim lines for non-hospital based provider-to-patient telehealth spiked 1,393 percent from 2014-18, according to a recent Fair Health report.