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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 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 Care Service Corporation is the licensee of the Blue Cross and Blue Shield Association for five states. It concentrates its operations in Illinois, Montana, New Mexico, Oklahoma, and Texas. HCSC is the fifth-largest health insurer in the US overall and employs more than 23,000 people.
Get Covered Illinois is the health insurance marketplace for the U.S. state of Illinois. The exchange enables people and small businesses to purchase health insurance at federally subsidized rates. Since its inception, over 388,179 Illinois consumers have gained health insurance coverage. [1]
to care for a seriously ill family member (spouse, son, daughter, or parent) (Note: Son/daughter has been clarified by the Department of Labor to mean a child under the age of 18 or a child over the age of 18 with a mental or physical disability as defined by the Americans With Disabilities Act, which excludes, among other conditions, pregnancy ...
As of April 19, 2014, 8.02 million people had signed up through the health insurance marketplaces. An additional 4.8 million joined Medicaid. [3] Enrollment for 2015 began on November 15, 2014, and ended on December 15, 2014. [4] As of April 14, 2020, 11.41 million people had signed up through the health insurance marketplaces. [5]
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