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Prior Authorization Trends & Opportunities

Prior Authorization Trends & Opportunities

FromMedicare Advantage For Health Plans


Prior Authorization Trends & Opportunities

FromMedicare Advantage For Health Plans

ratings:
Length:
12 minutes
Released:
Apr 1, 2024
Format:
Podcast episode

Description

While prior authorization serves as vital checks and balances, ensuring clinical quality and preventing fraud, the administrative burden it imposes on providers and payers alike has led to an industry-wide reevaluation of certain codes and an increased push towards technology for auto-approvals and Gold Carding. Now, it's up to payers to encourage provider adoption of the technology by offering platforms with user-friendly interfaces, intuitive design, and seamless workflows. Streamlining prior authorization improves the overall experience for payers, providers, and members to ensure timely care and a more efficient healthcare system. Tune in to discover: Current shifts in the industry to reduce administrative burden while maintaining clinical quality and medical necessity How plans are leveraging technology to gain insights and refine prior authorization processesWhat CMS is doing to ensure guidance and appropriate timeframes serve members' best interestsAbout Our Guest:Chris Hugenberger has been in healthcare software for nearly 20 years, working on operations, implementations, and product development for both the provider and payer sides. He has niche expertise in utilization management and prior authorization software. 
Released:
Apr 1, 2024
Format:
Podcast episode

Titles in the series (23)

Insider insights and perspectives for healthcare executives of government-sponsored health plans. We’re talking to the experts about the unique operating infrastructure necessary for profitability and providing a best-in-class member experience. Topics include technology, data security, operations, health management, member engagement, risk adjustment, quality measures, start-up and growth tactics, legal and regulatory.