by Hargun Ghai | Aug 28, 2025 | Grievance Management
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,...
by Nico Furletti | Jul 15, 2025 | Electronic Prior Authorization, Prior Authorization
Why Smarter Prior Authorization Is Essential for Managing GLP-1 Growth GLP-1 medications are creating new challenges for health plans due to rising demand and costs. Originally developed for type 2 diabetes, these drugs are now widely prescribed for weight management,...
by Hargun Ghai | May 15, 2025 | Electronic Prior Authorization, Prior Authorization
Current Industry Challenges 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...
by Hargun Ghai | Mar 27, 2025 | Electronic Prior Authorization, Healthcare Technology, Prior Authorization
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...
by Hargun Ghai | Mar 7, 2025 | Grievance Management, Healthcare Technology
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...
by Hargun Ghai | Feb 19, 2025 | Electronic Prior Authorization, Prior Authorization, Uncategorized
Agadia Expands Market Reach with a ePA Portal for Specialty Drugs Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access Agadia is proud to announce the expansion of its electronic prior authorization (ePA)...
by Hargun Ghai | Feb 10, 2025 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Last year, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), a significant step toward improving healthcare efficiency, enhancing patient access to care, and reducing...
by Hargun Ghai | Jan 23, 2025 | Electronic Prior Authorization, Prior Authorization
One of the most common and often misunderstood components of insurance plans is prior authorization (PA). While it might seem like an extra hurdle, PA plays a significant role in healthcare cost management and patient safety. What is Prior Authorization? Prior...
by Hargun Ghai | Jan 8, 2025 | CMS, Medication Therapy Management
The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver...
by Karen Apwah | Nov 25, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024 The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in...
