by Karen Apwah | Nov 7, 2023 | Electronic Prior Authorization, Healthcare Technology, Prior Authorization
As per an article published last Friday, House Democrats are pressuring the Centers for Medicare & Medicaid Services (CMS) to better evaluate how artificial intelligence is utilized by Medicare Advantage (MA) plans, hoping to prevent eye-catching rates of denial....
by Karen Apwah | Sep 18, 2023 | Electronic Prior Authorization, Prior Authorization
Pharmacy Benefit Managers (PBMs) play a pivotal role in ensuring access to cost-effective, quality treatments for self-funded employers and their members. One PBM stood out for its commitment to transparency and advanced clinical management, but they faced a challenge...
by Karen Apwah | Aug 31, 2023 | Electronic Prior Authorization, Prior Authorization
In the ever-evolving landscape of healthcare, streamlining processes while ensuring compliance is crucial to delivering efficient patient care. One significant challenge that has long plagued the healthcare industry is the manual and time-consuming process of...
by Karen Apwah | Aug 8, 2023 | Electronic Prior Authorization, Prior Authorization
In the dynamic realm of healthcare, striking a balance between providing optimal care for members and maintaining operational efficiency is a constant challenge. For Health Plans and Pharmacy Benefit Managers (PBMs), the ability to exercise flexibility and control in...
by Karen Apwah | Jul 10, 2023 | Electronic Prior Authorization, Prior Authorization
Introduction: In today’s complex healthcare landscape, Health Plans and Pharmacy Benefit Managers (PBMs) face significant challenges in managing their prior authorization (PA) programs efficiently and ensuring compliance with regulatory requirements. The...
by Karen Apwah | Jun 27, 2023 | Electronic Prior Authorization, Prior Authorization
Introduction: As the healthcare landscape evolves, it’s crucial for Health Plans and Pharmacy Benefit Managers (PBMs) to adapt to changing regulations and optimize their processes. A recent article published in the Federal Register sheds light on the Medicare...