5 steps to improving the claims adjudication process
“Is this claim valid? How much is our financial responsibility?” These are the two big questions payers want to answer when adjudicating healthcare claims. Huge […]
“Is this claim valid? How much is our financial responsibility?” These are the two big questions payers want to answer when adjudicating healthcare claims. Huge […]
Commercial insurers’ practices, such as prior authorization and white bagging, are needed to reduce costs for patients, said Kristine Grow, senior vice president of communications […]
Geisinger Health Plan is licensing Cohere Health’s AI-driven utilization management technology and services platform, designed to support value-based care delivery and streamline the prior authorization […]
The U.S. Surgeon General’s recent advisory about clinician burnout cited numerous societal, cultural, structural, and organizational causes—including excessive workloads, administrative burden, and lack of organizational support. The potential fallout of this trajectory is […]
What You Should Know: – Today Geisinger Health Plan (GHP) and Cohere Health, a provider of utilization management (UM) technology, announced they are joining forces to streamline the prior authorization process for […]
While many patients and physicians feel that it is increasingly difficult to get insurance to cover new treatments, a JAMA Viewpoint (Resneck 2020) demonstrates this […]
Pharma companies often take the blame for high prescription costs. But a new, industry-sponsored survey shifts attention to insurance industry practices.
Healthcare staffing shortages are patients’ biggest safety concern, according to a new study by ECRI. Pandemic pressures led many healthcare workers – clinical and non-clinical […]
An intelligent authorization platform relies on AI and machine learning to extract patient-specific data from a number of sources including the EHR. This helps health […]
What You Should Know: Free Market Health, a Pittsburgh-based healthcare technology company transforming the specialty pharmacy ecosystem with a care-driven marketplace platform, today announced its […]
Insurers’ abuse of prior authorization is creating health risks for patients and contributing to higher downstream costs for both beneficiaries and the larger health care […]
To get to the root of existing reimbursement problems, health plans should consider tackling genomic benefits management in a way that addresses test ordering and […]
Traditional revenue cycle management strategies are on shaky ground. Time-consuming manual processes are struggling under the burden of increasing patient volumes and patient financial responsibility. […]
Russ Graney, CEO and founder of Aidin Medicare’s annual enrollment period has started, and you know what that means: a slew of commercials suddenly appearing […]
Healthcare providers could be losing up to $265 billion each year on avoidable administration costs. A recent investigation by the Washington Post and McKinsey & […]
After more than a year of stop-and-start elective services, providers are ready to cut through the backlog and help patients get their healthcare back on […]
In the sixth article in our series on how the patient journey has evolved since the onset of COVID-19, we look at three ways to […]
The bill, if enacted into law, will establish an electronic prior authorization process and require Medicare Advantage plans to report on their use of prior […]
What You Should Know: – Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere’s digital prior authorization platform for musculoskeletal […]
Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct […]
Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct […]
Beginning July 1, Aetna now requires prior authorization for all cataract surgeries, across all its members and plans. Here in California and across the country, ophthalmologists are […]
This is the fourth in a series of blog posts that will highlight how the patient journey has evolved since the onset of COVID-19. In […]
It’s time to embrace electronic prior authorization that, according to a 2021 AHIP study, has been found to reduce the mean time from PA request […]
“The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. […]
The value of tech-enablement in a clinician’s day-to-day goes beyond our current outbreak scenarios. So much is still done by hand and faxed around that […]
What You Should Know: – Boston-based health IT company Cohere Health has closed a $36 million Series B funding round led by Polaris Partners, with additional participation from new investors Longitude […]
Cohere Health raised $36 million in a Series B funding round less than two years after its inception. It will use the new funds to […]
By HANS DUVEFELT The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed […]
Prior authorization is a massive and growing problem for patients and providers, and regulation is not likely to solve it completely or anytime soon.
What You Should Know: – Each year, the US healthcare industry spends $39 billion on 9 administrative transactions, according to a new report from CAQH. […]
Giri Rajaiah, Executive Leader, Vice President, Healthcare & Life Sciences, DISYS As the saying goes, necessity is the mother of invention. A similar correlation is […]
What You Should Know: – On the heels of $225.5 million dollars in funding and a $1.5B valuation this week, Olive today announced its acquisition […]
What You Should Know: – Cohere Health partners with health insurer Humana to modernize the prior authorization process for musculoskeletal treatment across 12 states. – […]
Prior authorization is a requirement that health plans require physicians to obtain plan approval in order to prescribe a patient a given medication. Prior authorizations […]
What You Should Know: – Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data […]
As the COVID-19 pandemic continues to change healthcare operations in the world, foundational systems are being adapted to meet these new demands. Sometimes it takes […]
What You Should Know: – Boston-based health IT start-up Cohere Health announced the official launch of its company with a $10 million Series A funding […]
With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. […]
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