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Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.
Some people think using artificial intelligence for so-called "prior authorizations" in the healthcare industry has become too excessive, fuelling public anger at insurance companies. "That's ...
Kentucky’s Medicaid program, like those of many other states, requires prior authorization before it agrees to pay for the medication. One managed care organization mandates such authorization every month.
In 2019, MA operators denied 13% of prior authorization requests that would have been accepted under traditional Medicare. [17] In 2019 alone, MA plans cost tax-payers $9 billion more than if those enrollees were in traditional Medicare. [18]
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CoverMyMeds is a healthcare software company that creates software to automate the prior authorization process used by some health insurance companies in the United States. The company was founded in 2008 and has offices in Ohio. Since early 2017, it has operated as a wholly owned subsidiary of McKesson Corporation. [3]