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Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [2]
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.
CoverMyMeds is a healthcare software company that creates software to automate the prior authorization process used by some health insurance companies in the United States. The company was founded in 2008 and has offices in Ohio. Since early 2017, it has operated as a wholly owned subsidiary of McKesson Corporation. [3]
The cyberattack on Feb. 21 paralyzed Change Healthcare, which is used by hospitals, doctors' offices, and pharmacies to process payments and prior authorizations for patient visits and prescriptions.
Restricting access to health care through tools like claim denials and prior authorization, which requires that insurers approve the care in advance, are among the ways that health insurers try to ...
UnitedHealthcare and other health insurance providers had high rates of prior authorization denials for patients in Medicaid-managed care plans, according to a report last year by the inspector ...
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
United Healthcare CEO Brian Thompson was shot dead on the street in New York City before he was to attend the company's annual investors meeting. (Photo by Stephen Maturen/Getty Images)
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related to: united health care prior authorization tool