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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.
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 ...
Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
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SAN FRANCISCO--(BUSINESS WIRE)-- Aetna (NYSE: AET) and Brown & Toland Physicians (BTP) today announced a new accountable care organization (ACO) model of health care that is designed to improve ...
Aetna, Riverside Health System Form Accountable Care Organization, Introduce New Products NEWPORT NEWS, Va.--(BUSINESS WIRE)-- Aetna (NYSE: AET) today announced an accountable care organization ...
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In 2015 CMS identified 254 quality measures for which providers may choose to submit data. The measures map to U.S. National Quality Standard (NQS) health care quality domains: [4]