Prior authorization (PA) is a widely used insurance mechanism intended to ensure cost-effective, evidence-based care. However, in practice, it often imposes significant administrative and clinical ...
Ohio is participating in a pilot program that will use artificial intelligence to determine approvals for around a dozen ...
"Medically necessary" is often a four-letter word for patients.
Transparency Scorecard to increase visibility into non-clinical dimensions of MA plan performance that fall outside the appropriate scope of Star Ratings.
Your office recently put out a request for information related to AI in healthcare. What are you hoping to learn from it?
Opinion
3dOpinion
Most insurance claim denials are due to clerical error. The system needs to be simplified.
Your doctor submits a claim to your health insurance. The claim is denied. You might be justified in thinking the denial is due to a medical disagreement. After all, adjudicating what health care ...
Payer scrutiny in spine and orthopedic care is intensifying, and surgeons say the biggest barriers to care come not from clinical uncertainty, but from rigid algorithms, prior authorization delays and ...
A summit hosted by Brown University’s School of Public Health brought together policymakers, researchers, health care leaders ...
LightPath Technologies, Inc. (NASDAQ:LPTH) Q2 2026 Earnings Call Transcript February 11, 2026 LightPath Technologies, Inc.
Kavita Nair, PhD, discusses integrating neurology and pharmacy services to improve MS care coordination and reduce treatment delays.
When patients pay the same no matter the health care option they choose, there’s no incentive for them to make judicious ...
Two Trump administration regulatory rollbacks affect nursing home staffing and homecare workers, and a new AI experiment in Medicare has alarmed eldercare advocates and congressional Democrats.
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