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Tag Archives: utilization management

The Prior Authorization Rule and Advancing Utilization Management Performance

Compliance & Regulation, Industry Spotlight, PodcastsBy MedecisionMarch 26, 2021

The latest episode of Liberation Lab focuses on the prior authorization rule affecting utilization management. Julie Barnes, JD, Founder and Principal of Maverick Health Policy, shares insight on what healthcare…

What the Interoperability and Prior Authorization Rule Means for the Patient Experience

Blog Posts, Compliance & Regulation, Cover StoryBy MedecisionMarch 25, 2021

What does the new interoperability and prior authorization rule mean for the patient experience? Julie Barnes, founder and principal of Maverick Health Policy, and Sarah Dencker, vice president of Network…

Leveraging Utilization Management to Reduce Medical Loss Ratio Rebates

Blog Posts, Compliance & RegulationBy Debbie Hill, MSN, RNMarch 18, 2020

Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health…

Utilization Management Requires TLC Under Value-Based Care Models

Smart + Digital Solutions, WhitepapersBy MedecisionNovember 21, 2019

As healthcare moves toward the full embrace of value-based care models, utilization management is increasingly leveraged as a means to not only manage costs but to ensure quality and manage…

Risk Sharing Requires Health Plans to Hone Utilization Management Process

Blog Posts, Compliance & RegulationBy Debbie Hill, MSN, RNOctober 1, 2019

Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.

“Utilization Management” is all about saving health plans money. Or is it?

Blog Posts, Compliance & RegulationBy Debbie Hill, MSN, RNJuly 2, 2019

Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.

Utilization management: What’s it got to do with population health?

Blog Posts, Compliance & Regulation, Smart + Digital SolutionsBy Debbie Hill, MSN, RNJuly 2, 2019

What does Utilization Management have to do with Population Health? The answer: everything.

Medecision Launches Aerial UM Connector™ to Drive In-Network Referrals and CMS Reporting Compliance for Government Health Plans and TPAs

Compliance & Regulation, Press Releases, Smart + Digital SolutionsBy Regena FriedenAugust 8, 2018

SaaS application connects provider contract and member enrollment details for real-time authorizations and referrals, eliminates costs and delays tied to manual utilization management and universe creation  DALLAS, TX – August…

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