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Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The Alabama Department of Public Health is the primary state health agency of the government of the U.S. state of Alabama. It provides a number of public health services to Alabama residents. [1] Chronically underfunded for decades, even by a health professional as governor (Bentley), it ranks near the bottom among states. [2]
What makes it promising: Cohere Health works with health plans like Humana and Geisinger to make the prior authorization process more efficient and accurate, using AI to save money for the plans ...
Prior to Medicare contracting reform in 2005, CMS awarded Cahaba a no bid contract. [ 5 ] : 2 In January 2009, Cahaba won a US$335 million 5-year contract with the CMS to administer Medicare insurance in 3 more states besides Alabama , Georgia , Tennessee and in Mississippi for part B Medicare.
Even for doctors trained in addiction medicine — motivated to treat opioid addicts with buprenorphine and able to work within Medicaid’s numerical limits — there are still roadblocks. Kentucky’s Medicaid program, like those of many other states, requires prior authorization before it agrees to pay for the medication.
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