Gold Carding Programs Are Meant to Improve Prior Authorization. Are They Working?
Several states and insurers have gold carding programs to streamline prior authorization. However, some say they're falling short.
How Health Plans Are Adding Up Real Value From AI
AI tools can work together across the payer value chain, exchanging information, collaborating and making autonomous decisions based on business rules. Here are just a few examples of how their bottom lines are benefiting.
Understanding EGPA: The Role of Eosinophils and Advancements in Treatment Options
FASENRA® (benralizumab) injection, for subcutaneous use, 30 mg is indicated for the treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA). FASENRA provides a treatment option for HCPs to consider when managing this challenging disease.
Therapists vs. Insurance: How AI Could End the Battle Over Mental Health Care
With these tools, therapists can reclaim their time, focus on their patients, and deliver the high-quality care that every individual deserves — all while maintaining the financial stability to thrive in their practices.
Video: What Would Happen If Prior Authorization Went Away?
Prior authorization is a sore subject for payers and providers. So what if it went away? In a recent fireside chat hosted by MedCity News, Don Antonucci, CEO of Providence Health Plan, shared his thoughts.
Blue Shield of California, Salesforce Partner to Modernize Prior Authorization
During HLTH 2024, Blue Shield of California and Salesforce announced a partnership that will streamline the prior authorization process.
Navigating the Government’s Medicare Advantage Prior Authorization Changes
The reintroduction of the "Improving Seniors' Timely Access to Care Act" marks a critical step toward modernizing the prior authorization process within Medicare Advantage plans. So, what does this mean for patients and providers moving forward?
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Why Your Patients Are Leaving and How to Stop It
Patient expectations continue to evolve, and healthcare practices that fail to adapt risk more than just revenue—they risk losing trust.
Report: MA Insurers Denied 3.4M Prior Authorization Requests in 2022
About 7.4% of prior authorization requests submitted to MA insurers were denied in 2022, according to a recent KFF report. Of these denials, only 9.9% were appealed.
Putting Payers in the Driver’s Seat: How the New CMS Interoperability and Prior Authorization is Changing Healthcare
As the industry embarks on this fundamental transformation, a few key questions must be answered.
Insurer “Delay and Deny” Practices Continue to Threaten Patients’ Timely Access to Gastrointestinal Care – It’s Time for Reform
Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.
Seven Trends to Watch in Healthtech AI
As the role of AI in healthcare settings continues to evolve and generate debate, here are seven things to keep an eye on.
Consultants: Help Define What’s Next In Healthcare Benefits
Help shape the future of healthcare benefits by sharing your insights.
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Is AI in Prior Authorization Promising or Dangerous?
AI can improve the prior authorization process, but there needs to be more transparency, experts said during a recent panel held by KFF.
CMS Finalizes Rule Streamlining Prior Authorization Process
CMS finalized a rule on Wednesday that included set deadlines for affected payers to complete prior authorization requests. Several organizations came out in support of the rule.
Unlocking Prior Authorization Access With a Green Lighting Approach
The real-time, automated nature of green lighting offers precise control without the setbacks or manual efforts inherent to conventional gold carding programs. This innovative new approach also ensures adherence to state-level and other gold carding regulations
What Do Physicians Really Think of AI?
Nearly half of physicians are equally excited and concerned about the use of AI in their field, according to a new AMA survey. Those who felt optimistic about AI cited reduced administrative burden as the number one benefit they’re seeking. Patient privacy and the impact to the patient-physician relationship were the most common reasons physicians cited for having reservations about AI.