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A number of legislative and technological developments attempt to optimize the prior authorization process: [16] In 2011, the American Medical Association recommended a uniform prior authorization form with real-time electronic processing. The proposed process would involve a physician ordering a medical service, their staff completing a ...
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 ...
In 1996, The Associated Group changed its name to Anthem Insurance Company. [17] In August 1997, Anthem acquired Blue Cross and Blue Shield of Connecticut. [18] It also sold Acordia to management. [19] In 1999, Anthem acquired Blue Cross and Blue Shield of New Hampshire and Blue Cross and Blue Shield of Colorado and Nevada. The acquisitions ...
The prior authorization, or pre-certification process, requires healthcare providers to get coverage approval for certain non-emergency procedures. Cigna removes pre-authorization requirement for ...
Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States–based federation with 33 independent and locally operated BCBSA companies that provide health insurance to more than 115 million people in the U.S. as of 2022.
As of 2017, the largest commercial plans were Aetna, Anthem, Cigna, Health Care Service Corp, UnitedHealthcare, and Centene Corporation. [27] As of 2017, there were 907 health insurance companies in the United States, [ 28 ] although the top 10 account for about 53% of revenue and the top 100 account for 95% of revenue.
Gail Koziara Boudreaux (née Koziara, born 1960) is an American businesswoman.She is the president and CEO of Elevance Health since 2017, and has been an executive for other health insurance companies including Aetna, BlueCross BlueShield of Illinois (2002), and UnitedHealth Group (2008).
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 ]