The critical need to improve prior authorization processes might have reached its tipping point on Jan. 17. That’s when the Biden administration announced its new mandate — the CMS Interoperability and Prior Authorization Final Rule — designed to effectively speed up the process for Medicare Advantage patients, providers and health plans.
Speed is only one of many inefficiencies surrounding prior authorization. And prior authorization cases are only one slice of the patient
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Prior Authorization
5 Ways AI Streamlines Prior Authorization Process for Providers & Patients
The prior authorization process, integral for confirming the necessity and insurance coverage of medical treatments, has historically been an obstacle in healthcare. In its current state, it has the potential to cause considerable delays and financial burdens for patients and healthcare providers - and the inefficiencies of this process are evident, as approximately 90% of providers report care delays due to this process (AMA), with a significant percentage indicating that some delays even lead
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Humata Health Secures $25M for AI-Powered Prior Authorization
What You Should Know:
- Humata Health, a company revolutionizing prior authorizations in healthcare with AI and automation raises $25M co-led by Blue Venture Fund and LRVHealth with participation from Optum Ventures, .406 Ventures, Highmark Ventures, and VentureforGood further demonstrates the widespread support for Humata's innovative approach.
- With this significant investment, Humata Health will expand its AI capabilities, broaden its provider base, and partner with payers to
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Parachute Health Launches Integrated Solution of DME Ordering with Prior Authorization
What You Should Know:
- Parachute Health, a platform for DME (Durable Medical Equipment) and HME (Home Medical Equipment) ordering, has announced a groundbreaking partnership to revolutionize the DME ordering process.
- The strategic collaboration aims to streamline ePrescribing, eliminate prior authorization burdens, and ultimately reduce costs for everyone involved.
Prior Authorization Headaches a Thing of the Past
The traditional DME ordering process is notorious for
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Evolent Acquires Machinify’s AI-Driven Medical Authorization Solution
- Evolent Health, Inc. (NYSE: EVH), a leader in improving health outcomes for patients with complex conditions, announced today an agreement to acquire key assets from Machinify, including the exclusive license to their AI-powered platform, Machinify Auth.
- Additionally, certain Machinify employees will join Evolent. Both companies plan to establish a long-term services agreement to ensure smooth integration and ongoing platform development. This innovative technology aims to
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SamaCare Secures $17M to Scale Specialty Drug Prior Authorization Platform
What You Should Know:
- SamaCare, a cloud-based patient access platform for specialty medications, today announced that it has closed an oversubscribed $17 million Series B investment round led by new investor Questa Capital.
- Questa is joined in the round by existing investors Vive Collective and South Park Commons.
SamaCare
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Humana Expands Use of Cohere Health’s Prior Authorization Platform
What You Should Know:
- Cohere Health, a recognized leader in clinical intelligence and prior authorization automation, announced that Humana Inc. (NYSE: HUM) will expand its use of Cohere's prior authorization platform for diagnostic imaging and sleep services.
- In January 2021, Cohere and Humana began a pilot
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DrFirst Acquires Myndshft to Expedite Access to Specialty Medications and Reduce Burden on Providers
What You Should Know:
- DrFirst has announced a strategic acquisition of Myndshft Technologies, Inc., an end-to-end real-time medical benefits and automated prior authorization (PA) software-as-a-service (SaaS).
- Myndshft software-as-a-service automates and simplifies time-consuming healthcare patient access tasks associated with prior authorization, eligibility and benefits verification, and patient financial responsibility, freeing providers and payers to concentrate more fully on
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AKASA Unveils Gen AI Assistant, Cuts Prior Authorization Time by 50%
What You Should Know:
- AKASA, a leader in generative AI (GenAI) solutions for the revenue cycle, today announced the launch of Authorization Advisor™.
- Authorization Advisor tackles the time-consuming and error-prone process of prior authorization, a major pain point for healthcare providers.
Prior Authorization Made Easy with AI
Prior authorization, a process requiring approval from insurers before delivering certain services, is a significant burden for healthcare providers. It
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Prior Authorization and Interoperability – Changing the Dynamics of Medicare
CMS and Medicare are trying to change the dynamics of American healthcare. No need to rehash the well-known issues but what is new is the change in the hotspot. For the last 20 years, Medicare Fee for Service has been the hotspot of spending and value. You’ve heard the mantra (which dates at least as far back as 1906 with George Bernard Shaw’s play, “The Doctor’s Dilemma”). If you pay a set rate the medical establishment has an incentive to increase volume. Now fast forward to today and Medicare
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