American Specialty Health Joins AHIP Initiative to Transform Pre-Authorization and Utilization Management

AHIP Objective for Efficient, Effective Utilization Management Systems Inherent in ASH's Innovative, Clinically Evidenced MSK Approach

SAN DIEGO, Dec. 16, 2025 /PRNewswire/ -- American Specialty Health's (ASH's) ongoing commitment to industry best practices on utilization management (UM) has led to joining  more than 60 full-service health plans nationwide in a voluntary commitment to streamline and standardize UM processes, which was announced by AHIP in June.

"ASH currently contracts with over 200 health plans nationally for clinical network and utilization management services. And, we will continue to support our clients and members through our commitments to making the utilization management processes better," said George DeVries, CEO and president of ASH. "Through our shared commitment with AHIP and partner health plans, we will implement enhancements to our proven processes to include adopting electronic prior authorization, reducing the scope of claims subject to prior authorization, ensuring continuity of care when patients change plans, and other measures."

DeVries added, "The goal is to accelerate decision timelines, minimize appeals, increase provider satisfaction, increase transparency, reduce patient friction, and expand access to affordable, quality care for millions of Americans."

ASH recently released a report on its Clinical Performance Systems highlighting the company's more-than-three decades of proven capability to deliver affordable and optimal health outcomes without the abrasion often associated with UM.

While certain UM activities have drawn public and regulatory scrutiny recently, not all UM practices are designed equally. UM can be implemented to deliver optimal member experiences with successful health outcomes as the ASH report shows.

Leveraging nearly four decades of commitment to quality and innovation, the ASH Clinical Performance System, rooted in best-in-class, evidence-based, and highly transparent clinical decision-making adheres to industry standards and regulations. ASH's Clinical Performance System minimizes administrative burden and delays for both providers and members while continuing to set norms for evidence-based, member-focused care.

"We've found our Clinical Performance System provides effective clinical oversight and promotes appropriate implementation of diagnostics and treatment interventions," said ASH Chief Health Services Officer Douglas Metz, DC. "The ongoing provider performance monitoring and oversight, using various provider education and engagement touchpoints, enable ASH's Clinical Performance System to effectively deliver 98% member satisfaction and appropriate clinical outcomes at an affordable cost to members and health plans."

High volume cases like physical therapy and chiropractic are effectively and transparently reviewed by clinical peer experts who understand the conservative delivery of these services driving to high member satisfaction. The ASH UM system manages services with highly efficient automation supported processes and online resources for submitting information for UM review. Through the implementation of the Clinical Performance System, ASH works with providers to produce consistent and predictable affordability and member satisfaction results.

According to ASH's 2024 clinical case study of musculoskeletal (MSK) health services reviewing almost ten million processed claims, ASH reported that 95% of members who received services from ASH's contracted network of over 126,000 providers nationally reported successful resolution of their chief complaint. Seventy-eight percent of these cases did not require medical necessity reviews (MNR) due to ASH's UM Tiering program. In the 22% of cases where MNRs were required, clinical peer reviews were completed within less than one business day to accelerate access to appropriate treatment.

ASH has long championed affordable, high-quality healthcare and has evolved the Clinical Performance System to include annual provider report cards, corrective action plans, focused provider education, and dissemination of over 550 policies and clinical practice guidelines that are publicly available to providers and members. Further, ASH credentials providers according to NCQA and URAC accreditation standards. The Clinical Performance System's ongoing analytics and Tiered UM program ensures that UM focuses on outlier or complex cases, and providers who require more oversight. This sustained focus has resulted in consistent member satisfaction and predictable affordability, validated by independent CAHPS^® survey results.

ASH's clinical programs resulted in 92% of members seen in 2024 reporting that they received all treatment they felt was necessary.

About American Specialty Health

Founded in 1987, American Specialty Health Incorporated (ASH) is a leading national musculoskeletal (MSK) HealthTech company with a provider network of more than 126,000 in-clinic and virtual providers. ASH provides MSK recovery solutions for chronic and acute conditions, leveraging technology and clinical performance systems to expedite claims, customer service resolutions, and clinical management activities. ASH provides benefit management and benefit administration for health plans, employer groups, and others. Accredited by NCQA, URAC, and HITRUST, ASH meets national health care standards. With almost $1 billion in annual revenue earned, ASH is a trusted partner covering more than 62 million members nationwide in our clinical network and fitness programs. For more information about ASH, visit ASHCompanies.com; follow us on LinkedIn and Facebook; or call 800-848-3555.

Media Contacts:
Jack Chirrick
American Specialty Health
(619) 557-2361
jackc@ashn.com

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SOURCE American Specialty Health Incorporated