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Centene Corporation is an American for-profit healthcare company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500 .
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.
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]
Maker-checker (or Maker and Checker or 4-Eyes) is one of the central principles of authorization in the information systems of financial organizations. The principle of maker and checker means that for each transaction, there must be at least two individuals necessary for its completion. While one individual may create a transaction, the other ...
Centene Corporation ; Columbia Insurance Group ; Commerce Bancshares (Kansas City) Dierbergs Markets (Chesterfield) Drury Hotels (Creve Coeur) Edward Jones Investments ; Emerson Electric ; Energizer (Town and Country) Enterprise Rent-A-Car ; Express Scripts (St. Louis County) Ferrellgas ; GoJet Airlines
Authorization hold (also card authorization, preauthorization, or preauth) is a service offered by credit and debit card providers whereby the provider puts a hold of the amount approved by the cardholder, reducing the balance of available funds until the merchant clears the transaction (also called settlement), after the transaction is completed or aborted, or because the hold expires.
Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2]
The ALFA Plugin for Eclipse is a tool that converts your Eclipse programming IDE to a dedicated editor of authorization policies using ALFA syntax. ALFA policies can then easily be converted into XACML 3.0 policies and loaded into your XACML policy management tool. [7]
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