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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.
Get Covered Illinois is the health insurance marketplace for the U.S. state of Illinois. The exchange enables people and small businesses to purchase health insurance at federally subsidized rates. Since its inception, over 388,179 Illinois consumers have gained health insurance coverage. [1]
The Illinois Department of Healthcare and Family Services (HFS), formerly the Department of Public Aid, [1] is the code department [2] [3] of the Illinois state government that is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing child support services to help ensure that Illinois children receive financial support from both parents.
There are some issues addressed by this review: drug abuse clinically, alteration of drug dosage, drug–drug interaction, and drug-disease interaction. [1] Measure and record the blood pressure for next therapy. This review seems the best review over all three reviews because it is the closest option of the ideal. [11]
An independent medical review (IMR) is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality ...
Health insurance premiums in America could rise to ‘highest in decades’ in 2025 — here are 3 ways to cut your healthcare costs ASAP. Maurie Backman. November 24, 2024 at 6:33 AM.
Health Care Service Corporation is the licensee of the Blue Cross and Blue Shield Association for five states. It concentrates its operations in Illinois, Montana, New Mexico, Oklahoma, and Texas. HCSC is the fifth-largest health insurer in the US overall and employs more than 23,000 people.
Wells Fargo senior economist Tim Quinlan wrote in a note to clients that Tuesday's data points to a "decent" holiday season for retailers. But there are some warning signs that consumer spending ...
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