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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 ...
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 to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
UnitedHealthcare and other health insurance providers had high rates of prior authorization denials for patients in Medicaid-managed care plans, according to a report last year by the inspector ...
An effort to improve the prior authorization process in Medicare Advantage plans failed to advance in the Senate in 2022 after the Congressional Budget Office estimated it would cost about $16 ...
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 ...
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
The New York State Department of Family Assistance may refer to: the New York State Office of Children and Family Services (OCFS)