Prior Authorization

Cohere Health, Humana Expand Partnership to Transform Prior Authorization Process

What You Should Know:  – Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere’s digital prior authorization platform for musculoskeletal (MSK) services, based on the success of its initial implementation.  – After rolling out the platform across 12 states in January 2021, Humana has made significant progress toward achieving its …

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No Surprises Act Summary: What providers need to know

Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct result of surprise billing, with a third of insured adults saying they’ve received an unexpected bill in the previous two years. What’s no surprise, then, is that two-thirds of US …

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No Surprises Act Summary: What your organization needs to know

Rising medical debt, now a staggering $140 billion, is the largest source of debt for American families. A large portion of this is a direct result of surprise billing, with a third of insured adults saying they’ve received an unexpected bill in the previous two years. What’s no surprise, then, is that two-thirds of US …

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Aetna’s prior authorization policy harms California patients

Beginning July 1, Aetna now requires prior authorization for all cataract surgeries, across all its members and plans. Here in California and across the country, ophthalmologists are going to great lengths to secure approval from Aetna for cataract surgery, while the backlog caused by prior authorization and delayed elective care during the Covid-19 pandemic only grows.

Automated prior authorization: getting patients the approved care they need

This is the fourth in a series of blog posts that will highlight how the patient journey has evolved since the onset of COVID-19. In this post, we address the fourth step – prior authorizations, and helping your patients get the approved care they need. This series will take you through the changes that impacted …

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Automating authorizations as patients return to care

“The entire healthcare industry was turned upside down by the pandemic. Procedures were pushed back, insurance companies gave policy holders a lot of mixed information. It has been a mess.” This is what one healthcare executive told us when we surveyed patients and providers on the state of patient access, in June 2021. Changing prior …

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Cohere Health Raises $36M to Automate Prior Authorization Between Payers & Providers

What You Should Know: – Boston-based health IT company Cohere Health has closed a $36 million Series B funding round led by Polaris Partners, with additional participation from new investors Longitude Capital and Deerfield Management, as well as existing investors Flare Capital Partners and Define Ventures. The round comes less than a year after the company launched, and only 3 months after …

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Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers

By HANS DUVEFELT The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed is not on our formulary or the dose is exceeding our limits.” Well, which is it? Nine times out of ten, the fax doesn’t say. They don’t explain what their …

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Healthcare Can Save $16.3B Automating Administrative Transactions, Report Finds

What You Should Know: – Each year, the US healthcare industry spends $39 billion on 9 administrative transactions, according to a new report from CAQH. – The 2020 CAQH Index also uncovered that by automating these transactions, the industry could save $16.3 billion annually–a 42% cost reduction. CAQH, released the eighth annual report measuring the …

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How Automation is Key to the Future of Healthcare Operations

Giri Rajaiah, Executive Leader, Vice President, Healthcare & Life Sciences, DISYS As the saying goes, necessity is the mother of invention. A similar correlation is seen in the quest to leverage innovation and out-of-the-box thinking to address key problems facing the healthcare industry. The ongoing COVID-19 pandemic has brought the immense pressure the U.S. healthcare …

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M&A: Olive Acquires AI Prior Authorization Company Verata Health

What You Should Know: – On the heels of $225.5 million dollars in funding and a $1.5B valuation this week, Olive today announced its acquisition of Verata Health to create a combined AI prior authorization solution for providers and payers under the Olive name. – Prior authorization is a $31 billion dollar issue in healthcare, …

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Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment

What You Should Know: – Cohere Health partners with health insurer Humana to modernize the prior authorization process for musculoskeletal treatment across 12 states. – In addition, the company has closed an additional $10M in funding led by Flare Capital Partners and Define Venture, bringing the company’s total funding to $20M. Health insurer Humana has …

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The problem with prior authorization

Prior authorization is a requirement that health plans require physicians to obtain plan approval in order to prescribe a patient a given medication. Prior authorizations may be put in place to insure medications are not used inappropriately or for payers to try to reduce cost. While prior authorization may help save money, delays in the …

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Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation

What You Should Know: – Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation. – The acquisition will create the first unified healthcare payments platform with both commercial and government payer connectivity, resulting in greater value for providers. …

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How Times of Crisis Spur Needed Change in Healthcare Delivery

As the COVID-19 pandemic continues to change healthcare operations in the world, foundational systems are being adapted to meet these new demands. Sometimes it takes extreme circumstances to see the cracks in a system. COVID-19 has exposed areas with more room for improvement in the healthcare system, such as optimizing operational efficiency. Organizations and individuals …

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Cohere Health Launches with $10M to Increase Transparency Across Care Journey

What You Should Know: – Boston-based health IT start-up Cohere Health announced the official launch of its company with a $10 million Series A funding round led by Flare Capital Partners. – The company’s patient journey-focused platform improves the notoriously difficult prior authorization process and replaces an existing patchwork of legacy, siloed processes, and antiquated …

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4 Ways Healthcare Organizations Can Establish Partnerships to Drive Innovation

With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment. Take Nebraska Medicine, for example. In the early 2000s, …

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