Clinical and administrative staff at many organizations are struggling with the issue of what "medically necessary" really means - even those who have reviewed the Medicare Benefit Policy Manual (MBPM ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Case management, with its standards of practice of patient advocacy and resource stewardship and its role as a liaison between patients, payors and the healthcare team, is in a unique position to ...

Our Health Care Group discusses what businesses need to know about a new law in Maryland that creates new requirements for health plans’ use of artificial intelligence in making coverage and treatment ...

The powerful hospital lobby has been pushing a bill, A.3789 (Weprin)/S.7297 (Hoylman-Sigal), that would mandate arbitrary and impractical timelines on utilization review decisions – the process that ...

California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a ...

While UnitedHealthcare will provide organizations with criteria to make status decisions for patients, it will not provide hospitals with the complete set of InterQual criteria. Q: As of May 1, ...