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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
As of 2018, about one-third of California was covered by Medi-Cal. It is administered by the California Department of Health Care Services, which operates it in accordance with California's Medicaid State Plan and Title XIX of the Social Security Act. [7] California relies on Affordable Care Act (ACA) funding to support the Covered California ...
Two state-based health insurance regulators is unusual in the United States, and has led to various additional work to synchronize laws. [3] This dual regulation arose due for historical reasons, and when the DMHC was created in 2000, the California legislature requested a report on merging the health insurer responsibilities with the CDI. [4 ...
California’s Proposition 35 is a battle over how state lawmakers can spend billions in health care dollars. It would make permanent a tax on health insurance plans, a charge that also allows the ...
Doctors, hospitals and health insurance companies in California will be limited to annual price increases of 3% starting in 2029 under a new rule state regulators approved Wednesday in the latest ...
More than 130,000 Sacramento-area residents could pay their health insurance costs with federal subsidies. Here’s how to determine your eligibility.
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