The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...

Whether pharmacies have a due process interest in determining whether an injured worker's care is necessary under the Workers' Compensation Act was one of the key arguments in the first session led by ...

I need to do a drug utilization evaluation (DUE) for a new product to be added to our formulary. What resources are available to develop a DUE? The formulary system encompasses facets of medication ...

California Gov. Gavin Newsom recently signed two bills regarding artificial intelligence (AI) regulations in the healthcare sphere. The first bill (SB 1120) requires a qualified human individual to ...

The Division of Workers' Compensation released a set of proposals Wednesday to penalize companies that drag their feet when they review medical treatments that doctors order for injured workers. In ...

Cone Health is a North Carolina-based nonprofit health system serving patients across 150 locations, including five hospitals and more than 120 physician practices. It had a peer review paper-based ...