Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Spending, Prescription Histories Identify Future High Cost Members

October 10, 2018 - An individual’s healthcare spending and prescription drug histories are among the most accurate predictors of future high costs, according to a new Society of Actuaries (SOA) report. SOA used claims data collected by the Health Care Cost Institute (HCCI) to determine which beneficiary characteristics best predict whether or not members will become high cost claimants. SOA...


Articles

Da Vinci Project Connects Payers, Providers, FHIR for Value-Based Care

by

Payer and provider members of the Da Vinci Project are undertaking a series of pilot projects exploring how to best leverage FHIR for data exchange to enhance value-based care. “Da Vinci is a collective initiative of concerned,...

CAQH CORE Urges Industry Collaboration on Prior Authorizations

by

CAQH CORE is urging healthcare payers, providers, and other stakeholders to promote industry-wide collaboration on how to improve prior authorizations. Leading provider and payer organizations, including AHIP, AHA, the BlueCross...

All-Payers Claims Databases May Increase Healthcare Price Transparency

by

Leveraging the data of all-payers claims databases (APCDs) could improve healthcare price transparency for consumers, according to testimony presented at a House Energy and Commerce Committee hearing. Jamie S. King, a professor at the USC...

Automated Claims Administration Could Bring Billions in Savings

by

Automated claims administration could bring around $11 billion in savings to health plans and providers if the technology is implemented more broadly, according to the latest CAQH Index. Payers should encourage providers to adopt...

Preventing Provider Fraud through Health IT, Data Analytics

by

Healthcare fraud is an industry-wide problem can impact a payer’s ability to protect their revenue streams and maintain financial integrity. Fraud costs the nation’s healthcare payers almost $68 billion annually. Between 3 and...

NYCHH Seeks $11.5M from UnitedHealthcare for Denied Claims

by

A New-York based health system has initiated arbitration with UnitedHealthcare in order to collect $11.5 million in denied reimbursement from claims. NYC Health + Hospitals, a public healthcare network that serves New York City’s...

How Can Payers Get Providers to Use Electronic Payment Systems?

by

Healthcare, an industry that lags behind others in technology adoption, is slow to embrace innovative solutions that address business challenges. For payers that want to implement electronic payment systems to improve claims reimbursement,...

GAO: Medicare DME Prior Authorization Programs are Effective

by

CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017 by controlling unnecessary spending, according to a new...

OIG: Medicare Could Save $367M by Auditing Improper Payments

by

CMS auditing systems failed to recognize that 61 percent of Medicare payments for outpatient physical therapy claims in 2013 were improperly filed, which cost the Medicare program nearly $367 million, says a new report by the OIG. Only...

Prior Authorization Issues Contribute to 92% of Care Delays

by

Prior authorization issues are associated with 92 percent of care delays and may contribute to patient safety concerns as well as administrative inefficiencies, according to a new survey from AMA. Payers should work to change their prior...

Medicare Advantage Evaluation Requires Transparent Claims Data

by

The growth of the Medicare Advantage (MA)  market requires the release of more claims data to evaluate the commercial and government impact of the program, according to a recent JAMA commentary from the Health Care Cost Institute,...

96% of Payers Are Committed to Electronic Prior Authorization

by

The vast majority of payers are committed to implementing electronic prior authorization solutions as a way to address administrative problems with prior authorization procedures, according to research published through the ePA National...

NCQA Seeks Stakeholder Comments on Updated HEDIS Measures

by

NCQA is seeking health plan, provider, and related stakeholder public comments to weigh in on updated HEDIS measures and the implementation of new measures related to chronic disease management. NCQA wants to implement measures related to...

How All-Payer Claims Databases Can Identify Wasteful Spending

by

An all-payer claims database (APCD) can hold data on millions of patients and the services they receive, giving payers, providers, and related stakeholders the ability to identify wasteful spending and develop strategies to cut costs and...

2018 Best in KLAS Taps Vendors for Claims Admin, Price Transparency

by

The 2018 Best in KLAS report ranked the best vendor solutions for payer claims administration, care management, price transparency, and payer analytics based on five industry performance criteria.    KLAS ranked vendor solutions...

VA Awards Accenture $62M Benefits IT Infrastructure Contract

by

Accenture received a one-year, $62 million contract by the VA’s Veterans Benefit Administration (VBA) division to improve the VBA’s technology infrastructure for delivering member benefits. Accenture Federal Services (AFS)...

Payers, Providers Pledge to Improve Prior Authorizations

by

AHIP, BCBSA, AHA, and other leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden. Leaders of organizations participating in the pledge...

All-Payer Claims Databases Offer Insights into Healthcare Spending

by

All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain healthcare services is...

How Payers Can Streamline Prior Authorization for Prescriptions

by

Prior authorization may allow payers to limit unnecessary spending on high-cost prescription drugs, but leading provider experts suggest that payers could do more to boost the efficiency of prior authorization procedures for clinically...

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...