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Overview. Prior authorization is a check run by some insurance companies or third-party payers in the United States before they will agree to cover certain prescribed medications or medical procedures. [1] There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a ...
Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan based in southeastern Pennsylvania. Keystone focuses on low-income residents in southeastern Pennsylvania counties including, Bucks, Chester, Delaware, Montgomery, and Philadelphia. The healthcare provider currently serves over 400,000 residents in the area.
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 ...
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Abortion is legal in Pennsylvania up to 24 weeks. Medicaid coverage is allowed in specific cases involving rape, incest or there is a threat to the mother's life. Seventeen states permit full ...
Number of employees. 900+. Website. www.healthpartnersplans.com. Health Partners Plans (HPP) is a non-profit hospital-owned health maintenance organization which provides Medicaid and Medicare to central and southeastern Pennsylvania residents. [1] Health Partners Plans has over 262,000 members throughout Pennsylvania and provides healthcare to ...
The Pennsylvania Department of Human Services is a state agency in Pennsylvania [2] tasked to provide care and support to vulnerable citizens. With a range of program offices, the department administers various services including eligibility determination, foster care, early childhood development, services for individuals with disabilities, long-term living programs, and management of ...