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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
(The Center Square) – New laws go into effect in Illinois Jan. 1 that will put new restrictions on the state’s health insurance industry. Gov. J.B. Pritzker said the Healthcare Protection Act ...
The Illinois Department of Healthcare and Family Services (HFS), formerly the Department of Public Aid, [1] is the code department [2] [3] of the Illinois state government that is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing child support services to help ensure that Illinois children receive financial support from both parents.
Key insurance industries it regulates include health insurance, auto insurance, homeowners insurance, and life insurance. [1] The department is the umbrella agency that operates the Illinois Health Benefits Exchange (IHBE), a health insurance marketplace that serves as an intermediary between Illinois residents and the health-insurance mandate ...
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Health insurance exchanges were established as a part of the 2010 Patient Protection and Affordable Care Act to enable individuals to purchase health insurance in state-run marketplaces. [2] In this legislation, states could choose to establish their own health insurance exchanges; if they choose not to do so, the federal government would run ...
The little girl, who has a heart murmur and complications after a bad bout of bronchitis, had been covered by Medicaid, the government program insuring low-income and disabled Americans.
President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010, in the East Room before a select audience of nearly 300 people. He stated that the health reform effort, designed after a long and acrimonious debate facing fierce opposition in the Congress to expand health insurance coverage, was based on "the core principle that everybody should have some basic security ...