Prior authorizations are the way MA managed care plans pre-approve some procedures before they’ll pay for them.

As managed care expands in the United States, few prescribed therapeutics today are purchased completely out-of-pocket. Rather, most are covered, at least in part, by a third-party payer ...

Given the prevalence of managed care, it’s incumbent upon the industry to ensure that there is a robust supplier pool.

STATEWIDE— NEW YORK STATE DEPARTMENT OF HEALTH'S eMedNY COMPUTER system improperly paid $16.2 million in Medicaid claims during a six-month period that started in October 2023, reports an audit that ...

After a dip in the wake of the release of UnitedHealth Group's Q4 2024 earnings figures, shares in the company and other ...

The contracts will involve tens of billions of dollars in the coming years, with about 3 million people receiving health care ...

The issue will feature guest editor Nate Apathy, Ph.D., from the University of Maryland School of Public Health in College ...

Significant changes to Florida's Medicaid managed-care system take effect this month, impacting millions of beneficiaries ...

LaTeena Smith pleaded guilty in December to submitting fraudulent bills for psychotherapy services for Medicaid managed care patients.

SoonerSelect, a new health care partnership, may help improve Oklahoma's health outcomes through collaboration between ...

Gold Coast Health Plan (GCHP) connected more Medi-Cal members with vital health care screenings and immunizations in 2023, surpassing regulatory health care quality metrics and ranking it as one of ...