Kanika Kapur is an associate economist at RAND in Santa Monica, California. Carole Roan Gresenz is an economist at RAND in Arlington, Virginia. David Studdert is an assistant professor of law and ...

While AI can be a useful tool, fewer nurses handling complex insurance cases could mean missed details and weaker appeals.

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 ...

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 ...

PLEASANTON, Calif.--(BUSINESS WIRE)--State Fund announced today that it will soon launch a revolutionary utilization review (UR) technology called UR Connected. The system will dramatically speed up ...

The utilization review process is designed to help hospitals determine the appropriate level of care and care setting for patients based on medical necessity. While this process is an expense for ...

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 ...

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The State University of New York (SUNY) along with University at Buffalo School of Pharmacy and Pharmaceutical Sciences began a partnership with the New York State Department of Health (NYSDOH) Drug ...

Colorado House Bill 25-1002, effective January 1, 2026, amends Colorado Revised Statutes § 10-16-104(5.5) to require health benefit plans to use nationally recognized, not-for-profit clinical criteria ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...