Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

For years, utilization management (UM) was quietly delegated away for scale, speed, and supposed efficiency. But today, health plans are hitting the breaking point. Prior authorizations, a core ...

“Healthcare utilization management has long been constrained by manual review and fragmented workflows,” said Ethan Siegel, Co-Founder of GenHealth.ai. “Our work with Guidehealth proves that AI can ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

This survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them. Objective: This study was designed to assess physician ...

California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...

Panelists discuss how utilization management policies can delay oncology care and call for reforms that better align oversight with clinical evidence. Panelists discuss how utilization management (UM) ...

GenHealth's AI-native UM platform integrates seamlessly with existing medical guidelines, administrative policies, and provider portals to automate data intake, escalation logic, and decision ...