Insights

Mounting prior authorization denials worsen hospital-payer relations

Nov 21, 2022 11:31:34 AM / by Aspirion posted in Patient Experience, Denial Management, Outpatient Care, Inpatient Care, clinical denials

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Prior authorization requirements have been around for decades, and frustration from providers is nothing new. But a new report suggests that abuse of these policies is compounding hospitals’ already cratering finances and pushing relations with health insurers to the brink.

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UHC sepsis-related changes to know

Jul 7, 2021 3:13:09 PM / by Aspirion posted in Denial Management, Complex Claims, clinical denials

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Beginning July 1, 2021, United Healthcare (“UHC”) will begin reviewing Medicare Advantage and commercial claims for sepsis-related treatment on a pre-payment basis and post-payment basis. Previously, UHC only reviewed sepsis-related claims on a post-payment basis. Payer policy changes, such as this, can have a lasting ...

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