Replacing human nurses with AI is absurd, but it's happening in New York, with technology provided by a company with significant penetration in KY.

While AI can be a useful tool, fewer nurses handling complex insurance cases could mean missed details and weaker appeals.

Kanika Kapur is an associate economist at RAND in Santa Monica, California. Carole Roan Gresenz is an economist at RAND in Arlington, Virginia. David Studdert is an assistant professor of law and ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

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 ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...