JD Supra

Did the PA Utilization Review Process Just Expand?

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 ...
Becker's Hospital Review

How hospitals can achieve an effective utilization review process

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 ...
Becker's Hospital Review

Humana, XSOLIS partner on predictive analytics platform

Humana will use healthcare technology firm XSOLIS’ predictive analytics platform to streamline parts of the utilization review process with providers. The payer will adopt the company’s various ...
JD Supra

Court of Appeals Affirms Ruling that Hospital Utilization Review Committee’s Medicare Part A Inpatient Reclassifications Trigger Appeal Rights Under Due Process

On January 25, 2022, the U.S. Court of Appeals for the Second Circuit affirmed a lower court ruling that the Secretary of HHS violated the due process rights of Medicare beneficiaries by failing to ...
Medscape

Drug Utilization Evaluations

I need to do a drug utilization evaluation (DUE) for a new product to be added to our formulary. What resources are available to develop a DUE? The formulary system encompasses facets of medication ...