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  • Insurers’ AI Denials of Postacute Care Face Senate Scrutiny
    UnitedHealthcare, Humana, and CVS faced criticism for using AI to deny Medicare Advantage postacute care authorizations, prioritizing profits over patient care Denial rates for postacute care
  • Electronic Prior Authorization Information - CVS Caremark
    CVS Caremark ® has made submitting PAs easier and more convenient Some automated decisions may be communicated in less than 6 seconds! We've partnered with CoverMyMeds ®, Surescripts ® and Arrive Health®, making it easy for you to access ePA based on your daily workflow What is ePA?
  • Insurers increasingly deploy AI and deny post-acute care: Senate
    It outlines attempts from UnitedHealthcare, CVS and Humana—which collectively cover nearly 60% of all MA enrollees—to use technology to reject prior authorization claims, all while reaping
  • Advancing our technology roadmap - Caremark
    CVS Health continues to invest in our claims adjudication platform, find ways to streamline our specialty platform, and introduce AI-powered technology to alleviate friction associated with prior authorizations
  • CVS Prior Authorization and Enrollment Information
    Sometimes, before a patient can get a certain drug, you’ll need to get approval first, which is called prior authorization CVS Caremark uses this to make sure the medication is really needed and not too costly The good news? CVS Caremark offers electronic prior authorization (ePA)
  • CMS-0057-F: Prior Authorization Compliance for Health Plans
    Electronic Prior Authorization API: Real-time electronic prior auth with 72h 7d turnaround deadlines + reasons for denial: Streamlines utilization management and avoids regulatory penalties: Payer-to-Payer Data Exchange: Auto-share clinical and claims data when a member changes plans: Ensures continuity of care and reduces duplicate procedures
  • Transforming Prior Authorizations with AI-Powered Automation - Availity
    Responsible AI is crucial in addressing prior authorization challenges, particularly in determining medical necessity Intelligent Utilization Management prioritizes transparency, blending AI with human clinician expertise Availity AI is tested and validated thoroughly by health plan clinical staff during implementation and continuously
  • How Automation and AI Agents Are Transforming Prior Authorizations
    Explore how AI and automation simplify prior authorizations, reduce denials, and enhance revenue cycle management Learn actionable strategies and key metrics





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