Prior authorization

Availity Responds to CMS Interoperability and Prior Authorization Final Rule with Advanced Solutions for Healthcare Interoperability

Retrieved on: 
Wednesday, March 27, 2024
Technology, Finance, Public Policy, Government, Healthcare Reform, Professional Services, Software, Health, General Health, Data Management, Principal, Fast Healthcare Interoperability Resources, Organization, Interoperability, FHIR, DTR, MIPS, Communication, Health Level 7, CHIP, CRD, Hospital, Prior authorization, Acquisition, The Final Rule, Medicaid, API, Documentation, PAS, Medicare, CMS, FFS, Health insurance

The Final Rule aims to enhance interoperability and streamline the prior authorization process by mandating certain health plans to implement specific Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources (FHIR®) APIs.

Key Points: 
  • The Final Rule aims to enhance interoperability and streamline the prior authorization process by mandating certain health plans to implement specific Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources (FHIR®) APIs.
  • The Final Rule requires health plans to support a FHIR API for prior authorization by Jan. 1, 2027.
  • The Final Rule requires provider organizations to attest to utilizing a Prior Authorization API to submit at least one authorization request in 2027.
  • Providers will be able to connect to Availity to access the Prior Authorization API for multiple payers.

Florida Cancer Specialists & Research Institute Shares Pharmacy Expertise To Advance Medically Integrated Oncology Care

Retrieved on: 
Wednesday, April 3, 2024
Real-World Evidence, RN, Success, BP, RRMM, Doctor of Pharmacy, BCPS, Selinexor, Incidence, Partnership, Physician, Manufacturing, Bachelor of Pharmacy, DNP, Nursing, Prior authorization, Pharmacist, Roger Hawkins (drummer), CAPM, MPA, BSN, Therapy, RPH, Pharmacy, Outcome, Safety, Infrared spectroscopy correlation table, Best practice, FCS, PACS, OCN, Data, Metric, Health care

FORT MYERS, Fla., April 3, 2024 /PRNewswire/ -- Florida Cancer Specialists & Research Institute, LLC (FCS) leaders and pharmacy experts will share insights and best practices in specialty pharmacy operations and dispensing that are contributing to positive patient outcomes at the NCODA 2024 Spring Forum in Dallas. The focus of the multi-day gathering, "Driving Optimal Strategies for Patient Care in Medically Integrated Oncology," is on the vital role of pharmacy involvement throughout the entire cancer care continuum.

Key Points: 
  • The focus of the multi-day gathering, "Driving Optimal Strategies for Patient Care in Medically Integrated Oncology," is on the vital role of pharmacy involvement throughout the entire cancer care continuum.
  • "Our Rx To Go team members continue to set the standard of excellence for medically-integrated oncology pharmacy and support services," said FCS President & Managing Physician Lucio Gordan, MD .
  • "They are well-equipped to contribute top-tier knowledge to help steer the future of oncology care."
  • NCODA is a globally recognized not-for-profit organization dedicated to building a patient-centered, medically integrated community of health care providers whose focus is to innovate the continuity of cancer care so that every patient receives the maximum benefit from their cancer treatment.

Evofem Reports $18.2 million of Phexxi Net Product Sales in 2023

Retrieved on: 
Wednesday, March 27, 2024
Constitutional right, SAN, Research, Prior authorization, Acquisition, Lactic acid, Patient, Pregnancy, Fourth, Woman, Note, Security, WAC, OTCQB, Marketing, Citric acid, Medi-Cal, Beauty salon

SAN DIEGO, March 27, 2024 /PRNewswire/ -- The company behind Phexxi® (lactic acid, citric acid, and potassium bitartrate) vaginal gel, women's health innovator Evofem Biosciences, Inc. (OTCQB: EVFM), today announced financial results for the fourth quarter and year ended December 31, 2023. Highlights include:

Key Points: 
  • Highlights include:
    Delivered $18.2 million of Phexxi net product sales in 2023, an impressive increase compared to 2022 given the 73% reduction in field force and absence of growth capital in 2023.
  • Sales and marketing expense was 64% of net sales for 2023, a key milestone for the Company and a significant improvement from prior years.
  • For the year ended December 31, 2023, net product sales were $18.2 million compared to $16.8 million in net product sales in the prior year.
  • For the three months ended December 31, 2023, net product sales were $4.8 million compared to $0.2 million in the prior year period.

Edifecs Solution Addresses New CMS Prior Authorization and Interoperability Mandate

Retrieved on: 
Wednesday, February 21, 2024
Technology, Hospitals, Other Technology, Software, Practice Management, Internet, Health, General Health, Data Management, EDI, Consent management, CMS, API, HIMSS, Interoperability, HCSC, FHIR, Rule, HIPAA, Medicare, HL7, Policy, Automation, Prior authorization, Machine learning, Medicaid, Trust, Health care

The two-time Best in KLAS award winning Edifecs interoperability solution includes its EDI and FHIR Gateways, which have been enhanced to address the provisions in the new Rule, including Prior Authorization and Provider Access APIs.

Key Points: 
  • The two-time Best in KLAS award winning Edifecs interoperability solution includes its EDI and FHIR Gateways, which have been enhanced to address the provisions in the new Rule, including Prior Authorization and Provider Access APIs.
  • In anticipation of the final rule, Edifecs has worked with customers, including a large regional Blues organization, to build a robust interoperability solution that expedites prior authorization, alleviating much of the manual effort and administrative burden.
  • The rule mandates the adoption of electronic prior authorization processes using a Prior Authorization API.
  • “The potential benefits of the Prior Authorization and Interoperability mandate extend beyond what CMS projects – increased efficiency, burden reduction, and patient empowerment,” stated Chris Lance, chief product officer, Edifecs.

Edifecs Tops Best in KLAS for CMS Payer Interoperability Category for the Second Year in a Row

Retrieved on: 
Friday, February 9, 2024
Technology, Finance, Accounting, Health Technology, Professional Services, Software, Practice Management, General Health, Health, Data Management, Cloud, Directory, Trust, Feedback, FHIR, Human, CMS, Collaboration, Research, Prior authorization, CAQH, EDI, ROI, Certification, API, Cryptocurrency

Edifecs’ KLAS-award winning interoperability platform now includes the FHIR API for Prior Authorization and EDI capability required to address all components of the CMS-0057-F mandate .

Key Points: 
  • Edifecs’ KLAS-award winning interoperability platform now includes the FHIR API for Prior Authorization and EDI capability required to address all components of the CMS-0057-F mandate .
  • The Best in KLAS award furthers Edifecs’ recognition as the market standard for administrative, clinical, and pharmacy interoperability.
  • “We are honored to be recognized by KLAS for the second year in a row in the CMS Payer Interoperability category.
  • This is a significant differentiator and a major contributor to Edifecs being awarded Best in KLAS for the second year in a row.

Availity Achieves CORE Certification on Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Rules

Retrieved on: 
Friday, February 9, 2024
Data Management, Health, Technology, Health Technology, Health Insurance, Software, General Health, HIPAA, Human services, Payment, Certification, Organization, Automation, Eligibility, Prior authorization, CAQH, Information exchange

Availity , the nation's largest real-time health information network, announced today that it achieved the CAQH Committee on Operating Rules for Information Exchange (CORE®) Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Certification Seals.

Key Points: 
  • Availity , the nation's largest real-time health information network, announced today that it achieved the CAQH Committee on Operating Rules for Information Exchange (CORE®) Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Certification Seals.
  • CORE has developed the Eligibility & Benefits, Claim Status, and Payment & Remittance Operating Rules to improve electronic data exchange related to eligibility, benefits, and claim status transactions and to streamline provider payment and claim reconciliation.
  • With billions of electronic transactions conducted by the healthcare industry each year, CORE Operating Rules facilitate the seamless and secure exchange of administrative data.
  • CORE Certification Seals for Prior Authorization & Referrals and Health Care Claim Operating Rules confirm that Availity can exchange electronic healthcare information for eligibility, benefits and claims status, and electronic funds transfer and electronic remittance advice in conformance with the CORE Operating Rules.

Cohere Health Raises $50 Million in Equity to Meet Increased Demand for AI-Driven Transformation of Prior Authorization Process

Retrieved on: 
Thursday, February 1, 2024
Traction, Growth, Medicare, AI, Patient, Polaris Partners, Health, Flare, Privacy, CMS, Prior authorization, Pharmaceutical industry

BOSTON, Feb. 1, 2024 /PRNewswire/ -- Cohere Health, a recognized leader in clinical intelligence and prior authorization automation, announced it has closed $50 million in additional equity funding. The funding was led by Deerfield Management, with participation from Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, and brings the total raised by Cohere to $106 million. The latest round of funding will fuel the company's expansion to meet the increasing demand for Cohere's intelligent prior authorization platform.

Key Points: 
  • New funding propels Cohere's expansion of intelligent prior authorization platform to drive better payer-provider collaboration, following CMS Interoperability and Prior Authorization Final Rule
    BOSTON, Feb. 1, 2024 /PRNewswire/ -- Cohere Health , a recognized leader in clinical intelligence and prior authorization automation, announced it has closed $50 million in additional equity funding.
  • The latest round of funding will fuel the company's expansion to meet the increasing demand for Cohere's intelligent prior authorization platform.
  • The Centers for Medicare & Medicaid Services Interoperability and Prior Authorization rule , finalized this January, will require health plan investment in advanced technology to ensure compliance with federal prior authorization requirements.
  • Currently, Cohere serves five health plans, processing 5.5 million intelligent prior authorizations annually for more than 15 million health plan members and 420,000 healthcare providers nationally.

Washington State HCA Removes Prior Authorization for Hormone-Free "In the Moment" Contraceptive PHEXXI Ahead of Huskies vs. Wolverines Championship Game

Retrieved on: 
Monday, January 8, 2024
Fee, HCA, Pregnancy, Lactic acid, Woman, Texas Longhorns, FDA, Hormone, Sugar Bowl, Sugar, Testosterone, OTCQB, Michigan Wolverines, Citric acid, Medicaid, Birth, Prior authorization, Birth control

SAN DIEGO, Jan. 8, 2024 /PRNewswire/ -- Multiple studies have shown that testosterone levels surge in men watching a favorite sports team compete. A major victory – like the Washington Huskies over the Texas Longhorns in the Sugar Bowl last week – can result in a 20 percent increase in testosterone for fans of the winning team. The hormone spike and overall thrill of victory can give rise to intimate celebrations requiring in-the-moment contraception to prevent unintended pregnancy.

Key Points: 
  • The hormone spike and overall thrill of victory can give rise to intimate celebrations requiring in-the-moment contraception to prevent unintended pregnancy.
  • Phexxi is the first and only locally-acting contraceptive gel approved by the FDA.
  • The improved coverage makes it that much easier for women on the state HCA's Managed Medicaid and Fee for Service Medicaid plans to get Phexxi.
  • Phexxi continues to be included on the Washington State HCA Preferred Drug List.

Adonis's Revenue Surges 9x, Capping Milestone Year for Innovative Revenue Cycle Technology Company

Retrieved on: 
Wednesday, December 20, 2023
Anomaly, Partnership, Health care, Synaptic, Baptist Health, Acquisition, Business Insider, Digital health, Automation, ROI, Logic, Heart, Insurance, CPO, RCM, Growth, Patient, Prior authorization, Dermatology, Data science, Pharmaceutical industry

NEW YORK, Dec. 20, 2023 /PRNewswire/ -- Adonis, a leading Revenue Intelligence and Automation platform, announced today a year of meaningful revenue growth and significant company milestones. These include a substantial investment round, prominent features, partnership announcements, and the launching of two new products – all helping to further Adonis's mission to deliver critical revenue outcomes that enable healthcare providers to deliver the highest form of clinical outcomes and care.

Key Points: 
  • NEW YORK, Dec. 20, 2023 /PRNewswire/ -- Adonis, a leading Revenue Intelligence and Automation platform, announced today a year of meaningful revenue growth and significant company milestones.
  • "Our vision is to empower billing and revenue teams across healthcare with our cutting-edge products so they can recover the revenue they deserve – and this is only the beginning.
  • We believe a dynamic specialty specific AI-driven payment collection process is integral to building an agile and innovative company like Adonis."
  • "Adonis's success to date is not an accident: challenges in revenue cycle management are both universal and well documented.

Virtusa Secures SIIA CODiE Awards for Best Artificial Intelligence Solution in Healthcare

Retrieved on: 
Thursday, July 20, 2023
Payment, Software and Information Industry Association, Education, Head, EVP, Prior authorization, Software, Patient, Algorithm, Gina Cody, Inbox Business Technologies, Artificial intelligence, SIIA, Health, Health insurance, Insurance, Health care, Virtusa

SOUTHBOROUGH, Mass., July 20, 2023 /PRNewswire/ -- Virtusa Corporation, a global provider of digital strategy, digital engineering, and IT services and solutions, is proud to announce that its Next-gen Prior Authorization for Payers solution has been named the best Artificial Intelligence Solution in Healthcare of 2023 as part of the annual SIIA CODiE Awards. The prestigious CODiE Awards recognize the companies producing the most innovative Business Technology products across the country and around the world.

Key Points: 
  • Virtusa earns prestigious industry recognition by SIIA for Best AI Solution in Healthcare Next-gen Prior Authorization for Payers.
  • SOUTHBOROUGH, Mass., July 20, 2023 /PRNewswire/ -- Virtusa Corporation, a global provider of digital strategy, digital engineering, and IT services and solutions, is proud to announce that its Next-gen Prior Authorization for Payers solution has been named the best Artificial Intelligence Solution in Healthcare of 2023 as part of the annual SIIA CODiE Awards.
  • The prestigious CODiE Awards recognize the companies producing the most innovative Business Technology products across the country and around the world.
  • "Our Next-gen Prior Authorization for Payers solution embodies Virtusa's commitment to revolutionizing the healthcare industry through cutting-edge artificial intelligence technology," said Mallesh Kalary, EVP and BU Head - Healthcare, Insurance, and Life Sciences, Virtusa.