The effectiveness of mediation as a primary tool to resolve pharmaceutical service denials by managed care is discussed. A three-month prospective randomized trial of 48 medical appeal cases involving ...
—A recent study investigating factors affecting VA service connection denial for PTSD claims related to military sexual trauma found that citing sexual harassment were more likely to be denied than ...
Payer denials are increasing in frequency and complexity, costing healthcare organizations billions. During a recent session at Becker’s Health IT + Digital Health + RCM Meeting in Chicago leaders ...
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Medicare to use artificial intelligence in 2026 that could increase denial of service rates
In a groundbreaking move, the Centers for Medicare and Medicaid Services (CMS) will introduce artificial intelligence (AI) into Medicare's prior authorization process starting January 2026. This pilot ...
Boris Vabson ([email protected]), Harvard University, Boston, Massachusetts. Andrew L. Hicks, Harvard University. Michael E. Chernew, Harvard University. Policy makers have been paying increasing ...
Insurance claim denials have risen 16% from 2018 to 2024, affecting access to essential medications like insulin and albuterol. Denials often result from formulary exclusions, step therapy, and ...
Denial rates have soared to unprecedented levels, transforming what was once a back-office nuisance into a boardroom-level issue for health systems. At Becker’s 13th Annual CEO + CFO Roundtable, two ...
MOBILE, Ala. (WALA) - Two words: prior authorization. Without it, your healthcare plan might not pay for your treatment. The doctors makes the request when the patient needs the treatment, like an MRI ...
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