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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 ...
There’s a misconception that prior authorizations (PAs) only exist to deny health care and treatment. At BlueCross, the majority of PA requests are approved. When taken properly, drugs can ...
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.
Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription.It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs.
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Despite the importance Medicaid places on providing access to health care, many states have inconsistent policies toward paying for medications used to treat opiate addiction. The American Society of Addiction Medicine surveyed each state’s Medicaid program to determine which medications are covered and if any limitations exist.
Police have issued an e-fit image as part of a renewed appeal to identify a man found dead in a canal 14 years ago. The man's body was found in the Fazeley Canal in Erdington, Birmingham, at about ...