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How Human and Artificial Intelligence Can Streamline Claims Reviews
- Amid the shifting landscape of medical claims, the rise of high-cost and complex claims has become a significant challenge for payers. Recent data from the Peterson Center on Healthcare and Kaiser Family Foundation highlights the shifting landscape of medical claims. Moderate claims decreased from 60% in 2004 to 45% in 2021, while higher-intensity...
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Blending Human Expertise & Technology to Improve Claims Negotiations
Out-of-network claims remain a challenge for a healthcare system looking to improve utilization and spending of services. For health plans, negotiating fair prices for out-of-network services is...Sponsored Article
Improving Payment Integrity with a Building Blocks Methodology
Healthcare costs are increasing, and health insurers can expect — by some estimates — to spend 7 percent more in 2024. In this environment, payment integrity teams have a strategic...Payers, Employers Support the No Surprises Act IDR Process in Court
The provisions of the No Surprises Act rule that detail the independent dispute resolution (IDR) process for out-of-network claims have been making waves in the healthcare space. The No Surprises Act...Sponsored Article
How a Consolidated Payments Platform Positively Impacts Payers
Healthcare payers and third-party administrators are facing increasing challenges with complex and outdated technology infrastructures while keeping pace in a competitive marketplace. Technology...Sponsored Article
The Critical Task of Assessing Healthcare Payment Infrastructure
Health plans and third-party administrators (TPAs) face increasingly stiff competition in today’s payer marketplace. According to a recent American Medical Association study of health insurance...Sponsored Article
Considering the Costs of Complex Healthcare Payment Infrastructure
Over the last two decades, the digitization of healthcare payments has created growing pains for numerous payers in the form of overly complex infrastructure. Today, health plans and third-party...Centene Managed Care Plans Will Pay Medi-Cal $215M for Overcharges
Centene must pay Medi-Cal, California’s state Medicaid program, over $215 million to settle allegations that it two of its managed care plans overcharged the program by reporting inaccurate...Sponsored Article
3 Payment Integrity Strategies for Payers in 2023
The healthcare system in the United States continues to face unprecedented levels of change. Providers are seeing lower admissions than before the pandemic while also facing rising labor and supply...Sponsored Article
Understanding the Cost of Ineffective Payment Integrity Operations
Effective payment integrity on the part of payers is not only essential to reducing administrative costs but also improving relationships with providers that ultimately benefit members. Administrative...Sponsored Article
How Plans Simplify Payment Integrity by Choosing the Right Partner
Effective payment integrity ensures that provider claims are processed efficiently and paid accurately. What’s more, a streamlined payment process reduces friction between payers and providers,...Sponsored Article
Why Payers Need to Modernize the Claims Payment Experience
Insurers are much closer to their vision of claims processing in 2030 than just a couple of years ago, according to McKinsey & Company. For commercial health payers, this means an integrated,...Sponsored Article
Benefits of an Integrated Healthcare Payments Platform to Payers
Increased digitization is coming to the payer space, and health plans with an integrated payment and communication platform will be able to reduce complexities and costs with claims management and free...Sponsored Article
The Unintended Consequences of Complex Healthcare Payment Systems
Fragmentation, inefficiency, and complexity are the byproducts of how health payers have arrived at the present moment. Decades of regulation and market forces have created a rather unwieldy collection...Sponsored Article
Understanding the Complexity of Healthcare Claims, Payments
While the healthcare industry has made significant strides in improving care quality and delivery, its approach to submitting and paying claims is wrought with complexity, inefficiency, and...Consumers Face Struggles with COVID-19 Testing Access, Coverage
More than 20 percent of consumers have experienced barriers to COVID-19 testing in the last six months, such as struggling to find a test or forgoing a test because there were no testing options...Sponsored Article
5 Reasons Why Payers Should Bolster Payment Integrity
Payers can elevate their payment integrity strategy to do much more than fraud, waste, and abuse prevention. A comprehensive payment integrity strategy is key to lowering costs and achieving higher...How Private Payers, Medicaid Cover At-Home COVID-19 Testing
A handful of the largest private payers are evenly split regarding whether they provide direct coverage for at-home COVID-19 testing, according to the Kaiser Family Foundation (KFF) which assessed both...ACHP Asks CMS To Set At-Home COVID-19 Testing Coverage Standards
In a letter to CMS, the Alliance of Community Health Plans (ACHP) has requested that the federal government establish certain requirements for at-home COVID-19 testing coverage. “We support the...Sponsored Article
