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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 will cover a prescribed procedure, service, or medication.
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 ...
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 ...
A bill moving through the Oklahoma Legislature seeks to put more transparency into the prior authorization process used by health insurance companies.. House Bill 3190 would require insurance ...
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 ...
Among these requirements, the Prior Authorization API is a crucial component designed to improve the electronic exchange of healthcare data and streamline the prior authorization process. AssureCare’s MedCompass, a CMS-certified platform, can seamlessly receive prior authorization requests via the FHIR-based API.
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.
The attack opened the floodgates for the public's frustration over prior authorization and claim denials. Denials have been on the rise as the industry turns to technology to help make the process ...