Provider Communication

How One Payer Tackled the No Surprises Act Provider Directory Rule

January 10, 2024 - Brian Marsella, president of Health Payment Systems (HPS) and Paymedix, was accustomed to the challenges of maintaining provider directories when he joined HPS and Paymedix in 2022. But two years into his tenure and two years after the No Surprises Act went into effect, it was clear the payer’s provider directory processes needed to...


More Articles

4 Key Strategies to Promote Effective Payer, Provider Alignment

by Victoria Bailey

Strong payer-provider alignment makes life easier for all healthcare stakeholders. While providers administer services to individuals, payers are responsible for reimbursing providers and ensuring members have coverage for their care....

How Payers Can Identify Providers for High-Performing Networks

by Victoria Bailey

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,...

BCBSTX Provider Network Expansion Improves Behavioral Healthcare Access

by Victoria Bailey

Blue Cross and Blue Shield of Texas (BCBSTX) is improving behavioral healthcare access for members with an expanded provider network and additional telehealth offerings. After the payer expanded its...

Blue Cross MA Expands Mental Health Resources, Provider Network

by Victoria Bailey

Blue Cross Blue Shield of Massachusetts (Blue Cross) continues to expand mental health resources for members, as spending on mental health services totaled over $1 billion in 2022. Since the start of...

Medicare Advantage Provider Directories Are Inaccurate, Study Finds

by Victoria Bailey

Medicare Advantage provider directories are inaccurate, hindering beneficiaries’ access to mental healthcare, according to a secret shopper survey conducted by the Senate Finance Committee. When...

81% of Entries Are Inaccurate in Provider Directories of 5 Large Payers

by Kelsey Waddill

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...

How One Payer Expanded the Boundaries of Maternal Healthcare Benefits

by Kelsey Waddill

Investing in maternal healthcare may seem like a natural decision on an individual level, given the influence that positive, healthy parenting can have on a person’s life and the many healthcare needs that parents face. In reality,...

Payer, Provider Collaboration May Improve Provider Directories

by Victoria Bailey

Health plan provider directories can be a helpful resource for patients, but they are not always accurate. A shared effort from health plans and providers that includes streamlining data collection and...

Providers Share Benefits of Medicare Advantage During COVID-19

by Kelsey Waddill

There has been a lot of valuable conversation around the benefits that Medicare Advantage health plans can offer to consumers, but now providers have offered their perspectives on this form of health...

BCBSOK, OUHP Settle Dispute, Work Toward Long-Term Contract

by Victoria Bailey

After months of negotiations, Blue Cross and Blue Shield of Oklahoma (BCBSOK) and OU Health Physicians (OUHP) settled their dispute and have agreed upon a contract that will keep the provider...

Value-Based Care Stunted by Misaligned Payer-Provider Relationship

by Emily Sokol, MPH

A misalignment between payers and providers on their definitions of value, frequency of communication, and trust in their partnership is impeding value-based care efforts, according to research from...

Supporting Safety Net Providers Through Value-Based Payments

by Emily Sokol, MPH

At the beginning of the coronavirus outbreak, many healthcare organizations halted elective procedures. While this helped increase hospital capacity for patients with coronavirus, it also took a...

The Building Blocks of an Effective Coronavirus Response Strategy

by Emily Sokol, MPH

Payers are in a unique position to respond to many aspects of the coronavirus from payment of testing and treatment to community education. But there is no playbook for appropriate or effective responses. In such unique circumstances,...

Building Payer-Provider Partnerships for Bundled Payment Models

by Emily Sokol, MPH

A bundled payment model born from a payer-provider partnership between Blue Cross Blue Shield Rhode Island (BCBSRI) and University Orthopedics has helped deliver a holistic, outpatient delivery of a...

Opposite Opinions on Cost of Care End Payer-Provider Contracts

by Kelsey Waddill

Two major payers were unable to seal their deals by the first day of the new year due to conflict over the appropriate cost of care. UnitedHealthcare and Houston Methodist have ended their...

Eliminating Waste, Promoting Value Across the Health System

by Emily Sokol, MPH

Healthcare spending accounts for 18 percent of the entire United States GDP. While nearly one-quarter of this spending is unnecessary and wasteful, removing waste from the healthcare system is a...

Strategies to Improve Payer-Provider Relationship, Data Quality

by Emily Sokol, MPH

The 4th Annual Value-Based Care Summit brought payers and providers together from across the country together to discuss best practices in value-based care. Open and frank discussions provided valuable...

Stakeholder Communication Key for Shift to Medicaid Managed Care

by Kelsey Waddill

North Carolina’s transition from a fee-for-service (FFS) model to Medicaid managed care has faced some challenges, but keeping open communication lines with stakeholders enables the state’s...

Anthem BCBS Expands Value-Based Care Options with Premier Health

by Jesse Migneault

Anthem Blue Cross Blue Shield has partnered with Ohio-based Premier Health to expand its value-based care offerings to its employer-based, individual and Medicare Advantage members. The agreement...