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Prior Authorization Topic Center

The Latest

Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Dr Brian Covino
Interview
Green Lighting Solutions to Address Barriers in Health Care Prior Authorizations
03/05/2024

Featuring Brian Covino, MD, CMO, Cohere Health

Featuring Brian Covino, MD, CMO, Cohe...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to...
03/05/2024
First Report Managed Care

Newsfeed

Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
News
Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?
04/05/2024
Dean Celia
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.
The increased scrutiny of prior...
04/05/2024
First Report Managed Care
Shannon Smith Headshot
Commentary
Adapting to Change: Navigating the New CMS Prior Authorization Guidelines in Health Care
04/02/2024

Shannon Smith, RN, BSN

Shannon Smith, RN, BSN
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry prepares for the Centers for Medicare & Medicaid Services (CMS) to implement new guidelines to streamline prior authorization procedures, significant operational changes are on the horizon for health care payers....
As the health care industry...
04/02/2024
First Report Managed Care
Dr Brian Covino
Interview
Green Lighting Solutions to Address Barriers in Health Care Prior Authorizations
03/05/2024

Featuring Brian Covino, MD, CMO, Cohere Health

Featuring Brian Covino, MD, CMO, Cohe...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to adopting electronic prior authorization in health care. With financial incentives and standardized processes, there is still room for improvement. An expert introduces the concept of green lighting, a data-driven...
There are several barriers to...
03/05/2024
First Report Managed Care
News
AHA Voices Concern Over CMS Payment Updates to LTC Hospitals
08/07/2024
The American Hospital Association (AHA) expressed deep concern in response to long-term care (LTC) hospital payment updates finalized by the Centers for Medicare & Medicaid (CMS) on August 1, 2024.
The American Hospital Association (AHA) expressed deep concern in response to long-term care (LTC) hospital payment updates finalized by the Centers for Medicare & Medicaid (CMS) on August 1, 2024.
The American Hospital...
08/07/2024
First Report Managed Care
Commentary
Payer-Provider Synergy: Aligning at the Fulcrum Points
08/05/2024
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. In this commentary, experts delve into strategies to help foster a collaborative relationship between...
Payer-provider collaboration...
08/05/2024
First Report Managed Care
News
Obesity Linked to Distinct Heart Muscle Abnormalities in Patients With HFpEF, Study Finds
08/05/2024
A recent study published in Nature Cardiovascular Research highlighted the significant impact of severe obesity on myocardial ultrastructure in patients with heart failure with preserved ejection fraction (HFpEF), revealing potential...
A recent study published in Nature Cardiovascular Research highlighted the significant impact of severe obesity on myocardial ultrastructure in patients with heart failure with preserved ejection fraction (HFpEF), revealing potential...
A recent study published in...
08/05/2024
First Report Managed Care
News
New Treatment Options Benefit Patients With Relapsed/Refractory Follicular Lymphoma
08/05/2024
Patients with relapsed/refractory follicular lymphoma tend to have a poorer response and shortened progression-free survival with each subsequent treatment, but new treatment options are emerging.
Patients with relapsed/refractory follicular lymphoma tend to have a poorer response and shortened progression-free survival with each subsequent treatment, but new treatment options are emerging.
Patients with...
08/05/2024
First Report Managed Care
Hayward
Videos
Evolving Health Care Contact Centers Into Drivers of Value-Based Care
07/31/2024
Discover how health care contact centers can transform into drivers of value-based care through AI, automation, upskilling agents, and rethinking workflows and metrics to improve patient outcomes and population health.
Discover how health care contact centers can transform into drivers of value-based care through AI, automation, upskilling agents, and rethinking workflows and metrics to improve patient outcomes and population health.
Discover how health care contact...
07/31/2024
First Report Managed Care
O & S
Interview
The Impact of Labor Shortages on Long-Term Care and Homecare
07/31/2024
Guest experts weigh in on the ongoing issue of labor shortages in the health care homecare industry as well as solutions for maintaining a robust, engaged, and well-trained workforce.
Guest experts weigh in on the ongoing issue of labor shortages in the health care homecare industry as well as solutions for maintaining a robust, engaged, and well-trained workforce.
Guest experts weigh in on the...
07/31/2024
First Report Managed Care
Gavin Magaha
Interview
Strategies for Managing Duplicate Discounts Under the 340B Drug Discount Program
07/31/2024
Discover insights from an industry expert on 340B policy and compliance as they delve into industry trends, potential reforms, and the future of drug discount programs in the health care landscape.
Discover insights from an industry expert on 340B policy and compliance as they delve into industry trends, potential reforms, and the future of drug discount programs in the health care landscape.
Discover insights from an...
07/31/2024
First Report Managed Care
News
Sun Exposure Linked With Lower Risk of Follicular Lymphoma
07/30/2024
High sun exposure in warmer months may protect against the development of follicular lymphoma, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
High sun exposure in warmer months may protect against the development of follicular lymphoma, according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
High sun exposure in warmer...
07/30/2024
First Report Managed Care
News
Updated CDC Recommendation for RSV Vaccination in Older Adults
07/29/2024
The Center for Disease Control and Prevention (CDC) vaccine advisory group updated its recommendation for the use of the respiratory syncytial virus (RSV) vaccine in older adults so that people ages 60 to 74 with certain underlying conditions...
The Center for Disease Control and Prevention (CDC) vaccine advisory group updated its recommendation for the use of the respiratory syncytial virus (RSV) vaccine in older adults so that people ages 60 to 74 with certain underlying conditions...
The Center for Disease Control...
07/29/2024
First Report Managed Care
Brian Esterly Headshot
Interview
Insights on the 2024 Medicare Physician Fee Schedule: Implications and Opportunities for Virtual Care Management Services
07/26/2024
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee...
The current Medicare Physician...
07/26/2024
First Report Managed Care

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