Medicare’s New AI Screening Program Is Denying Claims in 6 States. Here’s What Procedures It Targets.
Quick Read WISeR launched in 6 states targeting 13 Original Medicare procedures, such as epidural injections and cervical…
American Healthcare Has Normalized The Abnormal
We have normalized poor access and long wait times in US healthcare. getty I recently asked a simple…
‘Delay and deny’ insurance practices hinder health care, CT patients, doctors say
When Matt Conway tore his bicep delivering a table recently, there were numerous barriers to getting it fixed.…
AI Is Coming for Pharmacy Benefit Managers: Potential Winners and Losers
Quick Read The top pharmacy benefit managers face a structural threat from artificial intelligence, while AI-native vendors and…
US health insurers advance measures to standardize prior authorization requirements
April 24 (Reuters) – UnitedHealth and CVS Health said on Friday they have standardized data and submission requirements…
Anthem denies payment for emergency surgery
in this case Hien Shields underwent emergency spinal surgery after an accident to prevent permanent neurological damage. Anthem…
‘Is your plan for me to die?’: Cancer patients fighting for their lives — against health insurance red tape
Working for one of the largest health insurers in the country, Rachael Proffitt understands more than most Americans…
Does Medicare require prior authorization?
Does Medicare require prior authorization? Medicare Advantage plans often require prior authorization. But these coverage reviews are rare…
Medicare Tests Algorithms to Streamline Prior Authorization
Medicare is set to bring artificial intelligence (AI) into the core of its decision-making, testing whether algorithms can…
CMS trials prior authorization for select Medicare services
The Hubert H. Humphrey building in Washington, D.C., headquarters for the U.S. Department of Health and Human Services.…
Most Consumers Find Prior Authorization Is a Major Problem
About three-quarters of American consumers feel insurer prior authorization (PA) requirements are a problem, according to a survey…