Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

I need to do a drug utilization evaluation (DUE) for a new product to be added to our formulary. What resources are available to develop a DUE? The formulary system encompasses facets of medication ...

Whether pharmacies have a due process interest in determining whether an injured worker's care is necessary under the Workers' Compensation Act was one of the key arguments in the first session led by ...

Cone Health is a North Carolina-based nonprofit health system serving patients across 150 locations, including five hospitals and more than 120 physician practices. It had a peer review paper-based ...

Availity, the nation’s largest real-time health information network, celebrates the news that the country’s leading health insurers have pledged sweeping reforms to modernize the authorization process ...