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  2. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...

  3. Prior authorization - Wikipedia

    en.wikipedia.org/wiki/Prior_authorization

    After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual. [5]

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  5. Elevance Health - Wikipedia

    en.wikipedia.org/wiki/Elevance_Health

    Prior to June 2022, Elevance Health was named Anthem, Inc. [2] The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California , [ 3 ] Wellpoint, and Carelon. [ 4 ]

  6. National Provider Identifier - Wikipedia

    en.wikipedia.org/wiki/National_Provider_Identifier

    A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...

  7. Carelon Behavioral Health - Wikipedia

    en.wikipedia.org/wiki/Carelon_Behavioral_Health

    Prior to the acquisition, Beacon Health was the largest privately held company of its kind in the United States. The company is the product of a 2014 merger between Beacon Health Strategies, LLC and ValueOptions, Inc. [ 3 ] The company rebranded as Carelon Behavioral Health in 2023.

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  9. Anthem medical data breach - Wikipedia

    en.wikipedia.org/wiki/Anthem_medical_data_breach

    The Anthem medical data breach was a medical data breach of information held by Elevance Health, known at that time as Anthem Inc. . On February 4, 2015, Anthem, Inc. disclosed that criminal hackers had broken into its servers and had potentially stolen over 37.5 million records that contain personally identifiable information from its servers. [1]

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