In an early 2023 brief published by KFF, CMS transparency data for 2021 revealed an average denial rate of 17% for all in-network claims, with authorization denials reported as high as 24% of denial volume for some plans and medical necessity denial rates as high as 37% for others.
Ayble Health says it provides personalized nutrition and psychology services, Higher-risk patients will have expedited scheduling with Mayo Clinic multidisciplinary experts.
Study shows that MRI imaging can identify cortical lesions and the central vein sign that are informative in diagnosing multiple sclerosis.
A recent study conducted by AHIP revealed that MA plans have been proven to provide better access to preventive healthcare, helping reduce disease risk and detecting illnesses early on.
Rising healthcare costs impact their own organization’s competitiveness, said those who responded to the Pulse of the Purchaser survey by the National Alliance of Healthcare Purchaser Coalitions.
The report from the American Medical Association evaluates health insurer market share at the metropolitan statistical area level and national level.
Mike Tuffin is set to become AHIP's President and CEO from January 8, 2024, succeeding Julie Simon Miller.
Joe Kvedar, M.D., the immediate past chair of the association, is chairing the 35-member group that will be focused on eliminating barriers to telehealth and other types of virtual health.
Researchers of a study compared Israel's CVOID-19 booster rollout experience to the United States to ask the question: How many lives could the U.S. have saved if boosters were authorized sooner?
Leaders and clinicians say they are seeing better patient outcomes and a good return on their investments, according to a recent survey.
The application deadline to serve on the committee is Dec. 11.
Pharmacy benefit managers have been under pressure to simplify their complicated, obscure pricing tactics.
The authors found that patients who received DAA treatment had a five-year survival rate of 47.2% compared with 35.2% for untreated patients.
Electronic health records often do not record when someone has died. The deceased continue to get a variety of healthcare reminders.
As of today, 40 states and Washington, D.C., have expanded their Medicaid programs under the Affordable Care Act.
Cigna has been looking to sell its Medicare Advantage business, perhaps as a way to fend off antitrust objection to the deal.
CTTP is rare hereditary blood clotting disorder stemming from a disease-causing mutation in the ADAMTS13 gene. This gene plays a crucial role in producing the ADAMTS13 enzyme, responsible for regulating blood clotting.
FDA has approved a new therapy for HR positive breast cancer and announces plan to hold advisory meeting for Abecma in earlier treatment of multiple myeloma. In addition, Janssen has submitted a supplemental application for Rybrevant in NSCLC.
Pfizer and BioNTech released positive top-line data for their mRNA-based combination vaccine that targets influenza and COVID-19.
Prior to the IRA, there were no limits on beneficiary OOP spending throughout the year. However, by 2025 the IRA will introduce the $2,000 maximum OOP expenses.
Healthcare leaders discussed digital health during the recent American Heart Association conference, outlining the potential and pitfalls. Often, setbacks aren’t related to the technology.
This is the latest offering by Express Scripts that aims to bring transparency to prescription drug costs.
Payers must be early adopters of managing genetic testing through DEX Z-Codes, combined with science-based policies and policy adherence and claims editing technology.
The Biden administration is looking at a policy change that would enable more older Americans to get oral and injectable medications.
Ejection fraction is a key factor in how clinicians diagnose, classify and treat heart failure. But you might not know it if you depended solely on ICD-10 codes.
First in class, biosimilars, oncology drugs and even some generics have been added to Optum Rx’s list of exclusions for 2024.
Researchers reported positive results at the AHA meeting today from a small, 48-patient study of lepodisiran, a short interfering RNA therapy designed to reduce lipoprotein(a) levels.
