A recent opinion from the Commonwealth Court of Pennsylvania has changed the rules for Utilization Review and thrown open the doors to a new class of litigants. In Keystone Rx, LLC v. AmeriHealth (Fee ...

We aim to provide transparency in how Elevance Health plans address variations in clinical practices to ensure safe, ...

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 ...

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 ...

As most workers' compensation practitioners are aware, the utilization review process was one of the main aspects of the medical cost containment provisions of the 1993 amendments to the Workers' ...

The utilization review process, in which an employer may challenge the reasonableness or necessity of the medical treatment of an injured employee, was at issue in County of Allegheny (John J. Kane ...

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 ...

This article presents a methodology for utilization review which aids the local Professional Standards Review Organization (PSRO) in selecting optimal timing of Concurrent Stay certification by ...

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 ...

JACKSONVILLE, Fla.--(BUSINESS WIRE)--Availity, the nation’s largest real-time health information network, celebrates the news that the country’s leading health insurers have pledged sweeping reforms ...

On November 10, 2025, the California Court of Appeal, Second Appellate District, Division Three, issued its decision in Illinois Midwest Insurance Agency LLC v. Workers’ Compensation Appeals Board and ...

Gift Article 10 Remaining As a subscriber, you have 10 articles to gift each month. Gifting allows recipients to access the article for free. State Rep. Julie Rogers, D-Kalamazoo, on Wednesday ...