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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 ...
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. [5]
In 1999, Anthem acquired Blue Cross and Blue Shield of New Hampshire and Blue Cross and Blue Shield of Colorado and Nevada. The acquisitions made since 1996 added 850,000 policy holders. Among its customer base were 2.4 million PPO and 964,000 HMO enrollees. [20] In 2000, Anthem acquired Blue Cross Blue Shield of Maine. [21]
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.
Enrollees in such plans typically received no coverage for out-of-network costs (except for emergencies or with prior authorization). A 2016 study on Healthcare.gov health plans found a 24 percent increase in the percentage of ACA plans that lacked standard out-of-network coverage.
The introduction of the blue shield with the white cross as the heraldic device to represent Greece occurred on 26 February [O.S. 7 January] 1833, [13] when the regency council which was governing Greece on behalf of its first king, Otto, announced the official design for the coat of arms.
Derek J. de Solla Price (1922–1983) with a model of the Antikythera mechanism. Captain Dimitrios Kontos (Δημήτριος Κοντός) and a crew of sponge divers from Symi island discovered the Antikythera wreck in early 1900, and recovered artefacts during the first expedition with the Hellenic Royal Navy, in 1900–01. [32]
Authorization hold (also card authorization, preauthorization, or preauth) is a service offered by credit and debit card providers whereby the provider puts a hold of the amount approved by the cardholder, reducing the balance of available funds until the merchant clears the transaction (also called settlement), after the transaction is completed or aborted, or because the hold expires.
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