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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.
The Council for Affordable Quality Healthcare, Inc. (CAQH) is a non-profit organization [4] incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then renamed the Council for Affordable Quality Healthcare, Inc. on August 8, 2002.
Members in an Aetna preferred provider organization (PPO) and Managed Choice (MC) plan and who receive care from Brown & Toland primary care doctors became part of this program on January 1, 2013.
Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
The Medical Board of California (MBC) is a state government agency which licenses and disciplines physicians, surgeons and certain allied healthcare professionals in California. The Board provides two principal types of services to consumers: (1) public-record information about California-licensed physicians, and (2) investigation of complaints ...
LOS ANGELES--(BUSINESS WIRE)-- Aetna (NYSE: AET) announced today that it has reached agreement on a new contract with Prime Health, returning 13 hospitals to Aetna's Southern California network ...
In the 21st century, commercial payers were increasingly using litigation against providers to combat alleged fraud or abuse. [25] Examples included litigation between Aetna and a group of surgical centers over an out-of-network overbilling scheme and kickbacks for referrals, where Aetna was ultimately awarded $37 million. [25]
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related to: aetna precertification look up provider search california free