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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 Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. [1] Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount (ten percent or more, as of February 2014) are reviewed by states or the federal government to determine whether the ...
(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 ...
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]
Meanwhile, health care providers say the legacy of unwinding may not fully come into focus for years. “We have huge problems with chronic illness in adults that are costing the system a lot of ...
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.
Jose Melo, 52, is facing a murder charge after Naket Jadix Trinidad Maldonado, 31, was found dead on Monday, Dec. 30, 2024
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [ 1 ] [ 2 ] A discipline-specific process may be referenced accordingly (e.g., physician peer review , nursing peer review ).