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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]
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 ...
Lumenos was the pioneer and market leader in consumer-driven health plans. In December, WellPoint acquired WellChoice, a New York City-based Blue Cross Blue Shield provider, for approximately $6.5 billion, [45] making New York the 14th state in which WellPoint is a Blue Cross Blue Shield licensee.
CareFirst BlueCross BlueShield is a health insurance provider serving 3.5 million individuals and groups in Maryland and the Washington metropolitan area.It has dual headquarters in Baltimore, Maryland and Washington, D.C. [2] [3] It is a nonprofit organization and an independent licensee of the Blue Cross Blue Shield Association.