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  2. Prior authorization - Wikipedia

    en.wikipedia.org/wiki/Prior_authorization

    Prior authorization, or preauthorization, [1] is a utilization management process used by some health insurance companies in the United States to determine if they ...

  3. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    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.

  4. Step therapy - Wikipedia

    en.wikipedia.org/wiki/Step_therapy

    It is a type of prior authorization requirement that is intended to control the costs and risks posed by prescription drugs. The practice begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.

  5. Medicare Advantage - Wikipedia

    en.wikipedia.org/wiki/Medicare_Advantage

    In 2019, MA operators denied 13% of prior authorization requests that would have been accepted under traditional Medicare. [17] In 2019 alone, MA plans cost tax-payers $9 billion more than if those enrollees were in traditional Medicare. [18]

  6. CoverMyMeds - Wikipedia

    en.wikipedia.org/wiki/CoverMyMeds

    CoverMyMeds is a healthcare software company that creates software to automate the prior authorization process used by some health insurance companies in the United States. The company was founded in 2008 and has offices in Ohio. Since early 2017, it has operated as a wholly owned subsidiary of McKesson Corporation. [3]

  7. Health Insurance Portability and Accountability Act - Wikipedia

    en.wikipedia.org/wiki/Health_Insurance...

    Health Insurance Portability and Accountability Act of 1996; Other short titles: Kassebaum–Kennedy Act, Kennedy–Kassebaum Act: Long title: An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use ...

  8. Authorization - Wikipedia

    en.wikipedia.org/wiki/Authorization

    Authorization is the responsibility of an authority, such as a department manager, within the application domain, but is often delegated to a custodian such as a system administrator. Authorizations are expressed as access policies in some types of "policy definition application", e.g. in the form of an access control list or a capability , or ...

  9. Authorization hold - Wikipedia

    en.wikipedia.org/wiki/Authorization_hold

    Authorization hold (also card authorization, preauthorization, or preauth) is a service offered by credit and debit card providers whereby the provider puts a hold of the amount approved by the cardholder, reducing the balance of available funds until the merchant clears the transaction (also called settlement), after the transaction is completed or aborted, or because the hold expires.

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