Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...

The definition of UM has changed. Some of the results remain stubbornly the same (and unclear). While utilization management clearly has a role in healthcare, the jury is still out on its ability to ...

RICHARDSON, Texas, December 08, 2025--(BUSINESS WIRE)--MedeAnalytics, an industry pioneer in AI-powered enterprise healthcare intelligence, analytics, and data management, and Basys.ai, an innovation ...

Our Health Care Group discusses what businesses need to know about a new law in Maryland that creates new requirements for health plans’ use of artificial intelligence in making coverage and treatment ...

* Context.-Tests that are performed outside of the ordering institution, send-out tests, represent an area of risk to patients because of complexity associated with sending tests out. Risks related to ...

“Achieving URAC’s HUM accreditation underscores our dedication to delivering fair, impartial, and efficient healthcare review services,” said Jim Bobeck, Esq., CEO of FHAS. “It reinforces our superior ...