Health Care Service Corp., a health plan operator for 18 million members across Illinois, Montana, New Mexico, Oklahoma and Texas, is integrating artificial intelligence and augmented intelligence to ...

It’s 2 am. A patient is wheeled into the emergency department. The paramedic slams down the EKG – “it’s a rule-out STEMI.” The patient is rolled past triage and into an acute treatment room. The ...

Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care. The Center for Medicare ...

Have you ever walked into the pharmacy and been told that your prescription requires a prior authorization? But your healthcare professional prescribed something for you, and you brought in your ...

When a child or adolescent experiences an emergency related to mental health issues or continues to struggle with mental health issues in other levels of care, inpatient treatment may be needed.

The proposed rule aims to improve prior authorization for prescription drugs by establishing and requiring electronic prior ...

In American healthcare, Medicaid presents significant challenges, particularly regarding inpatient stay approvals. In recent years, Medicare and the Two-Midnight Rule have dominated discussions around ...

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both ...