As noted in the following article posted on AMJC.com by Kelly Davio, prior authorizations are having a significant negative impact on clinical outcomes and causing a delay in care. This challenge is the driving force behind Agadia’s prior authorization solution,...
In healthcare, regulatory oversight is constant. Organizations must demonstrate that grievance cases are resolved within mandated timelines, tracked appropriately, and documented with accuracy. The Centers for Medicare & Medicaid Services (CMS), for example,...
The healthcare industry is facing unprecedented challenges in streamlining prior authorization (PA) processes effectively. According to a report by the Arthritis Foundation, the average wait time for medical procedure PAs ranges from a few days to several weeks,...
Prior authorization (PA) is a process used by health insurance companies to determine whether certain medications, procedures, or treatments are medically necessary before approving coverage. While the goal is to control costs and prevent unnecessary treatments, PA...
In today’s rapidly advancing healthcare industry, managing grievances has become more complex than ever. With rising regulatory scrutiny, evolving patient expectations, and a growing demand for efficiency, health plans and pharmacy benefit managers (PBMs) need...
