California is one of 31 states that passed laws in 2025 limiting insurance companies’ use of prior authorization to approve ...
Bayes' theorem is a statistical formula used to calculate conditional probability. Learn how it works, how to calculate it ...
New Medicaid prior-authorization rules have advocates in Connecticut concerned about patients losing access to their ...
A new federal pilot program is changing how some seniors access healthcare under traditional Medicare. As of January 1, 2026, ...
Tollo Health recently formed subsidiary TolloCare, LLC ('TolloCare') initially targeted to provide telehealth services ...
Your office recently put out a request for information related to AI in healthcare. What are you hoping to learn from it?
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 ...
Transparency Scorecard to increase visibility into non-clinical dimensions of MA plan performance that fall outside the appropriate scope of Star Ratings.
Prior authorization is no longer just an administrative hurdle for ASCs; it is a defining constraint on growth. As authorization requirements expand, policies shift and payer scrutiny intensifies, ...
Ohio is participating in a pilot program that will use artificial intelligence to determine approvals for around a dozen ...
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 ...
"Medically necessary" is often a four-letter word for patients.
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