Humana will use healthcare technology firm XSOLIS’ predictive analytics platform to streamline parts of the utilization review process with providers. The payer will adopt the company’s various ...

For years, utilization management (UM) was quietly delegated away for scale, speed, and supposed efficiency. But today, health plans are hitting the breaking point. Prior authorizations, a core ...

A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies. Objectives: To (1) ...

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 ...

For years, delegating utilization management (UM) functions to third-party vendors was seen as a practical response to rising medical costs, regulatory complexity, and distributed networks. Vendors ...