{"id":10012,"date":"2023-11-06T12:15:07","date_gmt":"2023-11-06T12:15:07","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=10012"},"modified":"2023-11-08T11:29:27","modified_gmt":"2023-11-08T11:29:27","slug":"significant-change-coming-in-prior-auth-and-inpatient-determinations","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/significant-change-coming-in-prior-auth-and-inpatient-determinations\/","title":{"rendered":"Significant Change Coming in Prior Auth and Inpatient Determinations"},"content":{"rendered":"\n
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This is an exclusive interview conducted by DistilINFO with<\/strong> Jon Shreve<\/strong>, CEO at MCG<\/strong><\/p>\n\n\n\n <\/p>\n\n\n\n <\/p>\n\n\n\n Mr. Shreve oversees all facets of MCG growth and management. He was Chairman of MCG from 2002 to 2009, and he became its CEO in 2007. <\/p>\n\n\n\n 2. <\/strong>There is more legislation for gold carding, which is a blunt instrument \u2013 it is hard to get a heterogenous group of services\/providers to run the right analysis on.<\/p>\n 3. <\/strong>Payers are working hard to satisfy the demands, both in current constructs (fax\/portal) and in future interoperable approaches. It is hard for payers to trust automated processes, so they are working on what gives them more confidence.<\/p>\n<\/div>\n
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To start with, tell us about yourself, your career journey so far to being the CEO of MCG. <\/strong><\/div>\n<\/div>\n\n\n\n
As an organization, we focus on further automating the process to take the overhead out of these key decisions, on measuring the value that these changes produce, and on using and collecting data that allows us to further automate the decision-making processes.<\/div>\n\n\n\n
What are the top trends you see in Prior Authorization and how will they impact the industry? <\/strong><\/div>\n<\/div>\n\n\n\n
1. <\/strong>Significant pressure on payers to simplify the processes and speed up response times. This takes the form of PR and federal\/state legislation.<\/p><\/strong>\n
Nonetheless, health plans are starting to work now to make that date, as there are many moving pieces. This includes finalizing and codifying policies and guidelines and working with providers on interoperability. The biggest step may be working together with providers in what has been a challenging relationship.<\/div>\n\n\n\n
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