Greg Miller, chief growth officer at Lumeon, said the care environment is ripe for change and that automation can help with short staffing and alleviate costs.

Cigna is being sued for using algorithms to allegedly deny claims. The lawsuit, filed Monday in federal court in California, claims Cigna developed an algorithm known as PXDX to enable its doctors to automatically deny payments in batches of hundreds or thousands at a time for treatments that do not match certain preset criteria. This […]

Claiming that its old policy statements no longer reflect current market dynamics, the Federal Trade Commission has voted to rescind its prior statements of advocacy for pharmacy benefit managers, effectively ending the agency’s previously stated endorsement of PBMs. According to the FTC, the new statement pulling its advocacy is a response to PBMs’ continued reliance […]

The Office of Inspector General has released a report examining prior authorization patterns from seven managed care companies, and based on the findings is urging increased oversight of prior authorization denials in Medicaid Advantage.