The effectiveness of mediation as a primary tool to resolve pharmaceutical service denials by managed care is discussed. A three-month prospective randomized trial of 48 medical appeal cases involving ...

Clinical denials are complex and often require detailed documentation. This places an additional operational burden on already overburdened healthcare organizations and can require increased ...

—A recent study investigating factors affecting VA service connection denial for PTSD claims related to military sexual trauma found that citing sexual harassment were more likely to be denied than ...

Healthcare claims processing is rife with inefficiencies and financial strains marked by operational bottlenecks, rising denial rates and increasing administrative burdens faced by providers, ...

In a groundbreaking move, the Centers for Medicare and Medicaid Services (CMS) will introduce artificial intelligence (AI) into Medicare's prior authorization process starting January 2026. This pilot ...

Almost half of insured, working-age adults in the U.S. say they've received a medical bill, or copayment for a service, they expected to be covered by insurance. But despite the fact that one in five ...

The new year had barely dawned, and Kurt Barwis, president of Bristol Hospital and Health Care Group in Connecticut, was on the phone in the emergency room. His back was (literally) against the wall.