Medical Utilization Management The Rise of AI in Medical UM Where It Works and Where It Doesn’t AI is changing utilization management, but not in the way many expected. Thought Leadership AI in Healthcare Utilization Management The future of medical UM is not fully...
Executive Insight Build vs. Buy The UM Software Decision Health Plans Can’t Afford to Oversimplify Utilization management modernization is no longer just a technology conversation. It is an operational strategy decision. UM Modernization Interoperability Health Plans...
AI-Powered Prior Authorization Prior Authorization Is at a Crossroads: How AI Can Help Restore Trust Health plans are rethinking outsourced utilization management and embracing AI-enabled platforms that restore control, transparency, and operational efficiency....
Prior Authorization Automation Real Automation. Less False Promise. Prior authorization automation can streamline intake, reduce repetitive administrative work, improve workflow consistency, and support faster decision-making. But meaningful transformation starts with...
Executive Insight Medical Prior Authorization Isn’t Just Under Pressure.It’s Structurally Breaking. Why health plans need to rethink intake, clinical review, and decision workflows before outdated operating models create even greater pressure. Brandon Noffsinger...
CMS-0057-F: What’s Changing Nextand What Health Plans Should Focus On NowCMS is closing the gaps in prior authorization with more automation, stronger standards, and greater transparency—across all drugs, all programs, all payers.The Big Picture: CMS Is Closing the...
In prior authorization, speed and accuracy depend heavily on one critical factor: data. But much of that data, such as faxed forms, clinical notes, attachments, and supporting documentation, arrives unstructured, incomplete, spread across multiple sources and is...
The healthcare industry is entering a new phase of interoperability and efficiency. With the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) approaching, health plans and PBMs are preparing for significant changes that will reshape how prior...
Health plans and PBMs are being asked to do something that feels increasingly difficult: reduce costs, improve outcomes, and keep operations moving forward while working with smaller teams and tighter budgets. At the same time, administrative workloads continue to...
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,...
