She identified utilization management in the emergency department as one such area that could benefit from automation, as the current process is both time ... improve patient flow and decrease ...

The process is still used, however, as it’s currently the most effective way to achieve utilization management. “Right now, it’s a necessary evil,” he says.

Traditional utilization management also fails to deliver rich data on provider utilization patterns and network performance that can be shared between payer and provider. This hinders the development ...

NEW YORK--(BUSINESS WIRE)--VirtualHealth, provider of HELIOS, the leading SaaS care management platform, today announced the launch of a fully integrated, ground-breaking utilization management ...

Many employers and their health plan members assume that a utilization management program’s only goal is to approve or deny medical procedures and save costs for the health plan. But that's not the ...

Following a brief discussion on utilization management, ... And we try to have the flexibility in the management of this disease process. Neil Minkoff, MD: Now I’m going to be controversial.

The UR process is necessary to treat patients. Hospitals cannot admit Medicare beneficiaries without a UR plan. The Code of Federal Regulations (42 CFR 456 and 42 CFR 482.30) and the Medicare ...

LONDON--(BUSINESS WIRE)--Quantzig, a pure-play analytics solutions provider, has announced the completion of their latest big data analytics engagement on the health insurance marketplace. A ...

NEW YORK–(BUSINESS WIRE)–Jul 20, 2021– New York-based healthcare review organization NYCHSRO/MedReview, Inc. has been granted URAC accreditation for its Independent Review (IRO) a… ...

On Jan. 17, 2024, CMS issued the Interoperability and Prior Authorization final rule. 3 This rule mandates that affected payers (including MAOs) comply with new standards for coverage criteria and ...