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(Reuters) - Officials from the U.S. government asked UnitedHealth Group to expedite payments to healthcare providers in an open letter on Sunday, after a hack of the insurer's Change Healthcare ...
There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. [ 2 ] [ 3 ] A failed authorization can result in a requested service being denied or in an insurance company requiring the patient to go through a ...
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 ...
TennCare is the state Medicaid program in the U.S. state of Tennessee. TennCare was established in 1994 under a federal waiver that authorized deviations from the standard Medicaid rules. It was the first state Medicaid program to enroll all Medicaid recipients in managed care. [1]
Contact information, such as name, address, date of birth, phone number and email. Health insurance data, such as health plans/policies, insurance companies, member/group ID numbers and Medicaid ...
Change Healthcare processes about 50% of medical claims in the United States for around 900,000 physicians, 33,000 pharmacies, 5,500 hospitals and 600 laboratories.
Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world's ninth-largest company by revenue and the largest health care company by revenue. The company is ranked 8th on the 2024 Fortune Global 500. [4] UnitedHealth Group had a market capitalization of $460.3 billion as of December 20, 2024.
Change Healthcare is a vital lynchpin in the complex U.S. system for making and clearing insurance claims, connecting providers to not just UnitedHealth but also to CVS Health's Aetna, Elevance ...