prior authorization
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Cigna Cuts 25% of Medical Services from Prior Authorization Requirements
Cigna removed 25% of medical services from prior authorization requirements. This represents more than 600 codes, and includes 100 surgical codes, nearly 200 genetic testing codes, durable medical equipment, orthoses and prosthetics and other services, said Dr. Scott Josephs, chief medical officer of Cigna Healthcare.
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Congressman Launches Investigation into Medicaid Prior Authorization Denials
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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From Bottlenecks to Breakthroughs: Using Technology to Transform Specialty Medication Access and Affordability
We need a streamlined approach where stakeholders can perform all critical tasks — from enrollment and patient consent to prior authorization, from real-time benefit checks to financial assistance — on a central platform powered by a business rules engine, automated workflows, and real-time analytics.
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Medicaid MCOs Denied 1 out of 8 Prior Authorization Requests in 2019
Medicaid managed care organizations deny prior authorization requests at high rates, according to a recent report by the Office of Inspector General. Of the 115 MCOs the OIG analyzed, 12 had prior authorization denial rates above 25%.
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Payers Can Reform Prior Authorization to Make it Faster, Smoother But Will It Satisfy the AMA?
In a recent interview, Dr. Jesse Ehrenfeld, the president-elect at the American Medical Association, outlined how the major pain point of physicians has gone from the EHR to prior authorizations requests. But none of the individual efforts that payers are making is enough.
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MA Plans Rejected 2M Prior Authorization Requests in 2021
There were more than 35 million prior authorization requests submitted to MA plans in 2021, and 2 million were denied, according to KFF. Of those denied, just 11% were appealed. However, most of those appeals led to the denial being overturned.
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MedCity Influencers, Health Tech
5 Ways To Drive Intelligence Into the Prior Authorization Process
It’s time to stop thinking about prior authorizations as a transaction. Rather, PA is the start of a care episode that should be a smooth, well-coordinated journey for patients, their providers and their health plan.
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Mission (Im)possible: Overcoming the Status Quo In Health Coverage to Offer More Personalization
Remaining at or near the top of employers’ and consumers’ choices when it comes to health coverage will require insurers to make large investments in infrastructure, processes and people to overcome the status quo.
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AHA: 78% of Hospitals Say Experience With Commercial Insurers Is Worsening
Less than 1% of hospitals and health systems said their relationship is improving and the rest said it has stayed the same. The American Hospital Association specifically called out commercial insurers for their practices on prior authorization and claims denials and delays.
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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
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Senior healthcare advocates applaud House passage of MA prior authorization bill
The bill sets requirements relating to the prior authorization process for Medicare Advantage plans. The House’s decision is supported by several healthcare advocacy organizations, including Better Medicare Alliance and the American Hospital Association. AHIP, however, neither criticized nor celebrated the passage.
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American Hospital Association turns up the heat on commercial insurers in scathing report
Commercial insurers’ practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications at AHIP.
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Geisinger Health Plan addresses burdensome prior auth process with Cohere Health’s platform
Geisinger Health Plan is licensing Cohere Health’s AI-driven utilization management technology and services platform, designed to support value-based care delivery and streamline the prior authorization process.
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BioPharma, Pharma, Policy, Social Determinants, SYN
Drug-industry survey blames insurer practices for barriers to care
Pharma companies often take the blame for high prescription costs. But a new, industry-sponsored survey shifts attention to insurance industry practices.
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MedCity Influencers, Health Tech, Payers, Physicians
Overhauling prior authorization: How to achieve better outcomes at a lower cost
An intelligent authorization platform relies on AI and machine learning to extract patient-specific data from a number of sources including the EHR. This helps health plans better anticipate, manage and optimize member outcomes.
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Insurance company abuses are putting more patients’ care out of reach
Insurers’ abuse of prior authorization is creating health risks for patients and contributing to higher downstream costs for both beneficiaries and the larger health care system.
Promoted
Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
Promoted
Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
