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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 ...
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.
Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.
Open Dental, previously Free Dental, is a proprietary software tool for dental practice management. [3] It is written in the C# programming language compatible with Microsoft .NET Framework and was first released in 2003.
Zillow's top 10 hottest housing markets of 2025. The primary reasons Buffalo was number one again, according to Zillow? Job and wage growth, relative affordability and demand that outweighs supply.
This is a list of abbreviations used in medical prescriptions, including hospital orders (the patient-directed part of which is referred to as sig codes).This list does not include abbreviations for pharmaceuticals or drug name suffixes such as CD, CR, ER, XT (See Time release technology § List of abbreviations for those).
Here’s what you need to know about preapproval vs. prequalification. What is the difference between preapproved and prequalified? The main difference between prequalified and preapproved ...
Inflation heated back up again in November, but it likely wasn’t bad enough to keep the Federal Reserve from cutting rates next week. Consumer prices were up 2.7% for the 12 months ended in ...