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In February 2012, the Maryland Health Care Commission presented the state legislature a plan of a standardized, electronic filing system for prior authorization requests. [17] In response to a 2012 prescription e-filing bill, the Kansas Board of Pharmacies advocated for an electronic prior authorization process with immediate approval for ...
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 bill defines prior authorization as “the process by which utilization review entities determine the medical necessity and medical appropriateness of otherwise covered health care services ...
Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription.It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs.
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Medicare Advantage (Medicare Part C, MA) is a type of health plan offered by private companies which was established by the Balanced Budget Act (BBA) in 1997. This created a private insurance option that wraps around traditional Medicare .
The UVM Health Network and others are pushing the Vermont Senate to pass a House bill that would require health insurance companies to streamline. Vermont health care providers blame prior ...
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