by Hargun Ghai | Mar 27, 2025 | Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Prior authorization (PA) is a process used by health insurance companies to determine whether certain medications, procedures, or treatments are medically necessary before approving coverage. While the goal is to control costs and prevent unnecessary treatments, PA...
by Hargun Ghai | Mar 7, 2025 | Grievance Management, Healthcare Technology
In today’s rapidly advancing healthcare industry, managing grievances has become more complex than ever. With rising regulatory scrutiny, evolving patient expectations, and a growing demand for efficiency, health plans and pharmacy benefit managers (PBMs) need...
by Hargun Ghai | Feb 19, 2025 | Electronic Prior Authorization, Prior Authorization, Uncategorized
Agadia Expands Market Reach with a ePA Portal for Specialty Drugs Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access Agadia is proud to announce the expansion of its electronic prior authorization (ePA)...
by Hargun Ghai | Feb 10, 2025 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Last year, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), a significant step toward improving healthcare efficiency, enhancing patient access to care, and reducing...
by Hargun Ghai | Jan 23, 2025 | Electronic Prior Authorization, Prior Authorization
One of the most common and often misunderstood component of insurance plans is prior authorization (PA). While it might seem like an extra hurdle, PA plays a significant role in healthcare cost management and patient safety. What is Prior Authorization? Prior...
by Hargun Ghai | Jan 8, 2025 | CMS, Medication Therapy Management
The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver...
by Karen Apwah | Nov 25, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024 The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in...
by Karen Apwah | Sep 11, 2024 | Opioid Overutilization, Part D Star Ratings
The Centers for Medicare & Medicaid Services (CMS) recently finalized changes to the Medicare Part D Star Ratings for 2024, introducing several new initiatives aimed at improving the quality of care and enhancing patient outcomes. These changes not only affect how...
by Karen Apwah | Jul 17, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
Are you prepared for potential upcoming AI Guidelines in Prior Authorization? As AI continues to revolutionize various aspects of healthcare, including prior authorization (PA) management, it’s crucial for Health Plans and Pharmacy Benefit Managers (PBMs) to stay...
by Karen Apwah | Jun 6, 2024 | Grievance Management, Healthcare Technology
With ongoing challenges such as the COVID-19 pandemic, rising healthcare costs, and changing regulatory requirements, healthcare organizations face increasing pressure to ensure efficient resolution of member grievances while maintaining compliance with industry...
