CMS and AHIP Isn’t the Finish Line: It’s the Starting Gun for Prior Auth Innovation
Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.
Physician-led AI: Unlocking Clinical Productivity In Prior Authorization
By keeping our AI and ML grounded in real-world medicine, we can shape a future where prior authorization works smarter, faster, and better for everyone involved.
Solving Healthcare’s Provider Data Problem Starts with Interoperability
Break down the silos. Take control of your provider data.
Ochsner Health Scales AI Tool After Its Cuts Prior Authorization Time to Just 4-5 Minutes
Ochsner Health is expanding its use of Latent Health’s AI platform after its reduced medication prior authorization times to just 4-5 minutes. The technology is designed to both streamline pharmacists’ workflows as well as improve patients’ access to medications.
More Than 50 Health Plans Commit to Simplifying Prior Authorization
Several insurers, such as UnitedHealthcare, Aetna and Cigna, pledged to improve prior authorization. These changes include streamlining decision timelines and increasing transparency.
New Cohere Health Solution Aims to Streamline Clinical Reviews for Payers
Cohere Health introduced a new tool for payers called Review Assist. It is meant to support health plan clinical staff with prior authorization reviews and other use cases.
Managing Routine Radiology: An Opportunity to Control Costs and Improve Care
Managing routine radiology does not require the administrative burden of prior authorization. Instead, health plans can implement post-service, pre-payment automated management based on clinical guidelines.
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The 3 Best Options to Buy Telemedicine Carts for Neurology Care
Neurologists and health care practitioners must evolve with the world. Telemedicine carts assist in this evolution by serving as an intermediary between patients and doctors.
Why One Leader Is Calling Out Insurers’ Inaction on Prior Authorization
The current prior authorization process in U.S. healthcare constitutes a crisis, according to Jesse Ehrenfeld, immediate past president of the American Medical Association. Prior authorization is wasting clinicians’ time, delaying care and deepening public distrust — yet, payers show little urgency in fixing this problem, he said.
What is Concurrent Review?
While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients.
A Four-Part Roadmap for Responsible Prior Authorization
The tools exist today to significantly reduce PA's burden on our healthcare system, we just need to mobilize and implement them.
Cohere Health Snags $90M to Automate the Much-Maligned Prior Authorization Process
Cohere Health raked in $90 million in Series C capital, taking its total funding to date to $200 million. This round of funding cements Cohere as the emerging winner in the prior authorization tech category, according to Michael Greeley, general partner at Flare Capital Partners.
The Human Algorithm: What AI Can’t Replace in Pharma Engagement
At a time when AI is reshaping pharma, Reverba Global CEO Cheryl Lubbert explained in an interview why empathy, context, and ethics still require a human touch.
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.
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.