Health Information Exchange

CMS Finalizes Payer Requirements to Streamline Prior Authorization

January 17, 2024 - CMS has finalized requirements for payers to streamline the prior authorization process and improve the electronic exchange of health information to help limit patient care disruptions. The CMS Interoperability and Prior Authorization Final Rule includes policies for Medicare Advantage organizations, Medicaid and the Children’s Health...


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KLAS: Epic’s Payer Platform Generates High User Satisfaction

by Victoria Bailey

Healthcare organizations using Epic’s payer platform are satisfied with the product’s performance, including its ability to deliver meaningful information without disrupting workflows,...

What Technologies Support Payers With Claims Management Processes?

by Victoria Bailey

Claims management is an integral part of the healthcare process as it determines how much providers receive in reimbursement, what costs health plans will cover, and what patients ultimately owe for their care. After providing care,...

Priority Health, Epic Partner to Improve Patient Data Exchange

by Victoria Bailey

Priority Health has announced a partnership with Epic and plans to implement the EHR vendor’s payer platform to facilitate patient data exchange with providers, lower healthcare costs, and...

How to Overcome Challenges in Gathering Racial, Ethnicity Data

by Kelsey Waddill

Collecting accurate race and ethnicity data is a critical step in moving the healthcare industry towards greater health equity. Having accurate race and ethnicity data enhances payers’ ability...

Benefits of Digital Quality Measures for Payer Quality Reporting

by Kelsey Waddill

When a major crisis hits, gathering quality measures data can be challenging or nearly impossible with the current strategies. In order for a health plan to be accredited by the National Committee for...

How Medicare Successes Inform Medicaid Value-Based Care Progress

by Kelsey Waddill

CMS has issued a letter to Medicaid directors regarding how states can accelerate their Medicaid value-based care adoption, based largely on lessons learned in CMS efforts toward value-based care in...

Cigna, Sentara Healthcare Join Payer Blockchain Initiative

by Jessica Kent

Cigna and Sentara Healthcare have joined a new healthcare-focused collaborative that aims to build, share, and deploy solutions using blockchain technology. The collaborative also includes Aetna,...

Payers to Focus on Price Transparency, Data Exchange at HIMSS19

by Jessica Kent

Price transparency, data exchange strategies, and the challenges of addressing administrative burdens will be among the key discussion topics for payers at this year’s HIMSS Global Conference and...

Aetna, Anthem, HCSC Back Healthcare Blockchain Initiative

by Kyle Murphy, PhD

Aetna, Anthem, and Health Care Service Corporation announced a new partnership with IBM and PNC Bank focused on bringing blockchain technology to healthcare. “The aim is to create an inclusive...

BlueCross BlueShield Strikes Deal to Improve Health Data Exchange

by Chuck Green

In an agreement that will support physicians and upgrade health outcomes for its members, BlueCross BlueShield of Western New York has announced a partnership with HEALTHeLINK. It will enable local...

Aetna Joins Healthcare Blockchain Alliance, Pilot Project

by Kyle Murphy, PhD

Not long after closing its deal to be acquired by CVS Health, health payer Aetna has signed on to pilot the use of blockchain technology as part of the Synaptic Health Alliance. In a statement with...

APMs, Health Data Exchange among Top Payer Reform Goals

by Thomas Beaton

The National Academy of Medicine (NAM) offered policymakers and stakeholders healthcare reform priorities, including alternative payment models (APMs) and health data exchange, that aim to lower...

Top Ways Payers Integrate Patient Engagement Strategies

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) announced last week the creation of the CMS Person and Family Engagement Strategy, The CMS Blog states. This CMS initiative is meant to stimulate...

How Payers Could Improve Population Health Management with Tech

by Vera Gruessner

When payers transition their reimbursement structures toward a value-based care payment model, healthcare quality improvement needs to be addressed. In order to boost quality, payers could target...

Key Ways Payers Could Improve Medical Claims Management

by Vera Gruessner

Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems...

3 Key Steps for Health Payers to Meet HEDIS Quality Measures

by Vera Gruessner

Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality...

Top Three Ways Health Information Exchange Benefits Payers

by Vera Gruessner

When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their...