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[2] [3] A failed authorization can result in a requested service being denied or in an insurance company requiring the patient to go through a separate process known as "step therapy" or "fail first." Step therapy dictates that a patient must first see unsuccessful results from a medication or service preferred by the insurance provider ...
A Regional Health Information Organization (RHIO, pronounced rio), also called a Health Information Exchange Organization, is a multistakeholder organization created to facilitate a health information exchange (HIE) – the transfer of healthcare information electronically across organizations – among stakeholders of that region's healthcare system.
The goal of the HIE is to deliver the right health information to the right place at the right time – providing safer, timelier, efficient, effective, equitable, patient centered care. In doing so, CRISP offers a suite of tools aimed at improving the facilitation of care for their service region's providers.
The outcome of the case has implications for more than 650,000 patients booted from Medicaid by ... for Florida’s government healthcare system is set to begin Thursday in a federal, class-action ...
The report found that 8 in 10 calls to Florida's Medicaid call center were automatically disconnected from the phone system. When people managed to get through, there were long delays to reach ...
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 ...
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
With EHR data from more than 120 million patients from leading US health systems, including clinical notes and images, Truveta Data is representative of inpatient and outpatient care from more than 900 hospitals and 20,000 clinics serving patients from across the US. Truveta Data is updated daily for the most current view of patient care.