How Payers Can Identify Providers for High-Performing Networks
Enrolling in the right health plan can significantly influence healthcare costs and consumer health outcomes. Despite significant healthcare spending, the United States has the worst health outcomes among high-income countries. In 2021,...SCAN, CareOregon Grants Help Eliminate $110M in Medical Debt
SCAN and CareOregon have granted $345,000 to a nonprofit organization that helps eliminate medical debt, a move expected to erase $110 million in debt for residents across five states. RIP Medical...UnitedHealthcare Pays $91.2M After Underpaying Envision for Medical Care
After underpaying the medical group for essential care, UnitedHealthcare has been ordered to pay $91.2 million to Envision Healthcare (Envision). An independent three-member panel of the American...Anthem, Valley Health Resolve Lawsuit Over Past-Due Payments
Regional health system Valley Health has reached a settlement agreement with Anthem Blue Cross and Blue Shield, resolving a dispute over past-due payments for healthcare claims, according to a press...81% of Entries Are Inaccurate in Provider Directories of 5 Large Payers
Most of the entries in the five large insurers’ provider directories have inaccuracies, a research letter published in JAMA Open Network explained. The researchers compared physician information...What the Prior Authorization Proposed Rule Means for Payers
The CMS Advancing Interoperability and Improving Prior Authorization Processes proposed rule introduces new requirements for healthcare payers that aim to enhance patient data sharing and streamline...Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer
Out-of-pocket costs for buprenorphine prescriptions for opioid use disorder treatment decreased between 2015 and 2020, but costs varied by payer, according to a study published in JAMA Network...CA, AZ Payers Boost Care Access for Active-Duty Service Members
Blue Shield of California and Blue Cross Blue Shield of Arizona will help boost access to care for active-duty service members and their families in the TRICARE West Region by supporting a contract...Blue Cross NC Scholarship Program Aims to Diversify Health Insurance Industry
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and two partners are forging a career pathway for local students to enter the health insurance industry and other insurance industries. The...Subsidies Drive Individual Health Insurance Marketplace Enrollment
Enrollment on the individual health insurance marketplace has grown with most enrollees finding their health plan through the Affordable Care Act marketplace, according to enrollment data compiled by...Payers Leverage Technology to Boost Maternal Health Outcomes
Payers are implementing new programs that capitalize on telehealth and partnerships with technology companies to better engage pregnant members and improve maternal health outcomes. There has been an...Sponsored Article
How Payers Overcome Nursing Shortages to Improve Patient Experience
While Medicare continues to ramp up efforts to reward quality over quantity of services, payers find themselves strapped for personnel to ensure the collection and reporting of care quality data. More...UHG Makes $25M Social Determinants of Health Donation To Housing Fund
UnitedHealth Group has dedicated $25 million toward a fund that will bolster development projects for mixed-income housing to address social determinants of health in New England. The fund is called...Sponsored Article
How Payers Can Deliver Value Through Care Management Models
Now more than ever, healthcare consumers are looking for value from their health plans. Traditionally, value has centered on the quality of clinical care and the total cost of care for those services....Sponsored Article
How Nurses Enable Health Plans to Support Members Aging in Place
The United States population is aging, with an influx of Baby Boomers set to dramatically increase the population of individuals over age 65 by tens of millions. According to the Federal Interagency...Sponsored Article
