STAT

JANUARY 17, 2024

The Biden administration moved Wednesday to force insurance companies to give specific reasons for denying coverage, and to speed up the pre-approval process in general. The new rule applies to health insurance companies that offer Medicare, Medicaid, Children’s Health Insurance Program, and Obamacare plans.

Insurance Coverage and Processing 340

Insurance Coverage and Processing Health Insurance Companies Hospitals 340

Integra X Files

MAY 22, 2023

Prior authorization has been popular with the insurance industry because it works. This is known as the sentinel effect, and in the initial stages, providers accommodated the process without much complaint. The health insurance industry didn’t have many other tools to suppress demand, so it went with the sentinel effect by default.

Insurance Coverage and Processing 94

Insurance Coverage and Processing Health Insurance Companies 94

Viseven

JULY 11, 2023

The largest non-profit provider of behavioral healthcare in California used Salesforce Nonprofit Cloud to meet the increasing demand for mental health services and automate their workflow. The provider’s team used to spend 80 hours processing a list of potential clients. With Salesforce, they do it for 15 minutes.

Health and Personal Care Stores 40

Health and Personal Care Stores Insurance Coverage and Processing Scheduling Appointments Communication 40

Ramblings of a pharmacist

APRIL 23, 2023

Separately, I don’t believe that 90-day supplies actually drive true adherence or clinical improvement - they just move the process measure of PDC. And downstream health effects of PBM coverage decisions don’t even enter into the spreadsheet - PBMs are about drug cost, and drug cost alone. They do… to a point.

Insurance Coverage and Processing 76

Insurance Coverage and Processing Independent Pharmacies Diabetes Health Insurance Companies 76

Express Pharma

JANUARY 12, 2024

Due to the multiplicity of regulatory processes and multiple regulators, undertaking operations become complex and time consuming. IRDAI has included the health insurance coverage for 12 such modern treatment methods under Chapter V of the Guidelines on “Standardisation of exclusions in health insurance contracts”.

Insurance Coverage and Processing 52

Insurance Coverage and Processing Pharmaceutical Companies Pharmaceutical Companies Health Insurance Companies 52