July 31, 2017

Hospitals Rein in Drug Costs for Inpatients As drug prices rise, hospitals double down on tried-and-true pharmacy management strategies By: Maggie Van Dyke  June 7, 2017 When Cleveland Clinic launched an initiative to control drug costs, Jeff Rosner, senior director of pharmacy contracting and purchasing, was skeptical. Knowing the pharmaceutical marketplace as he did, he […]

July 12, 2017

KEPRO to Implement Minnesota’s Retrospective Review Program for State Medicaid Jul 10, 2017 KEPRO announced that it was awarded a new contract with the state of Minnesota Department of Human Services to perform all retrospective, post-payment reviews for the state’s fee-for-service Medicaid program. KEPRO will be developing and implementing the state’s first program to conduct […]

July 12, 2017

Memorandum of Decision Plaintiff Richard J. Huerth resided at and received care at Milton Health Care, LLC (“MHC”), a skilled nursing facility (“SNF”) in Milton, Massachusetts, from 2007 to 2016. Beginning in 2013, when Huerth’s health insurance plan switched claim administrators to Anthem Blue Cross Blue Shield, 43 claims for services he received at MHC […]

June 28, 2017

BloodCenter of Wisconsin launches hematology genetics test panels Milwaukee, Wis. – June 26, 2017 – BloodCenter of Wisconsin’s Diagnostic Laboratories, part of Versiti, today announced the launch of seven hematology genetics test panels. The new test panels enhance and expand BloodCenter’s genetic testing capability to include a vast array of non-malignant hematology disorders, including platelet […]

June 26, 2017

DARK Daily: Utilization Management of Clinical Laboratory Tests Is Hot Trend as Labs Strive to Demonstrate Value, Get Paid More for Lab Testing Services June 21, 2017 08:00 AM Eastern Daylight Time AUSTIN, Texas–(BUSINESS WIRE)–To offset decreased lab budgets and shrinking payments from health insurers, the nation’s best-performing hospital and health system clinical laboratories are […]

November 20, 2016

On Wednesday, November 18, 2015, the federal government published Final Rules addressing the internal claims and appeal processes, along with external review requirements, that were originally established through the Affordable Care Act (ACA).  To find out more, click here.

September 3, 2016

As of July 1, 2015, Wyoming has updated the external review request period. To find out more, click here.

September 3, 2016

On July 1, 2016, Michigan chaptered HB 4933 – 4935 which makes several important changes to the state’s internal grievance and external review processes. The bills have been assigned Public Act No. 276 with immediate effect. The bill will become law on July 13, 2016. H.B. 4933 makes changes to Michigan’s Patient’s Right to Independent […]

February 3, 2016

The Case Management Society of America (CMSA) has included information on RegQuest’s recently published Utilization Management Regulatory & Market Trends: 2016 Annual Report in the February edition of their monthly eNewsletter, CMSA Today. Click here to check it out!

January 3, 2016

Thank you to all who attended our recent webinar titled Analyzing Trends in Utilization Management: A Focus on Regulations! This session reviewed information on the scope, licensure requirements, reviewer qualifications and the ways in which utilization management (UM) services are often integrated into a dynamic “care coordination” approach that may incorporate case management and disease […]