Important Updates in AI and Healthcare Coverage for 2024

Discover the groundbreaking shifts shaping the future of healthcare in 2024. Explore how AI tools are revolutionizing Medicare Advantage Insurance Plans, enhancing diagnostic accuracy, and predictive modeling. Delve into the journey from concerns raised in 2023 to the implementation of new federal regulations in 2024, ensuring AI algorithms align with Medicare coverage criteria. Witness the emphasis on individual circumstances and human oversight in healthcare coverage decisions, empowering every insurance member with the right to appeal denial decisions. Welcome to the era where technology meets compassion in shaping personalized healthcare solutions.

What is Buy and Bill? Everything You Need To Know

Exploring the buy-and-bill process in healthcare, this blog post delves into its advantages, challenges, and best practices for optimizing specialty drug administration

Prior Authorization Staffing: The need for certified experts

In a healthcare landscape burdened by delays and financial strains, the Prior Authorization Certified Specialist (PACS) Program emerges as a beacon of hope, offering accredited, self-paced training to bridge the knowledge gap, streamline processes, and significantly improve outcomes for both providers and patients.

Medicare Part D Out of Pocket Smoothing

Discover the transformative power of Medicare Part D Out-of-Pocket Smoothing in managing healthcare expenses. Uncover how this provision ensures financial predictability and improved healthcare access for Medicare beneficiaries, paving the way for a stable healthcare journey.

Navigating Prior Authorizations in Dermatology

Explore the challenges and solutions to the rising costs of dermatologic medications and the impact of prior authorization on patient care. Learn about the driving factors behind the increasing prices of biologics and common dermatologic drugs, and the efforts to improve the prior authorization process for healthcare providers and patients.

340B Drug Pricing & Prior Authorizations

A growing number of complex, expensive medications are entering the market. At the same time, health insurance companies, also called payer, are increasingly relying on utilization management to control healthcare costs by influencing patient care decisions. Common utilization management tools include prior authorizations, step therapy, predeterminations, and preauthorizations.