Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

All-Payers Claims Databases May Increase Healthcare Price Transparency

July 18, 2018 - 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 Hastings College of Law, told the committee that APCDs could address price transparency challenges if stakeholders use the millions of claims within AP...


Articles

Automated Claims Administration Could Bring Billions in Savings

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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 technologi...

Preventing Provider Fraud through Health IT, Data Analytics

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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 1...

NYCHH Seeks $11.5M from UnitedHealthcare for Denied Claims

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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 five...

How Can Payers Get Providers to Use Electronic Payment Systems?

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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

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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 Government...

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

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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 116 ...

Prior Authorization Issues Contribute to 92% of Care Delays

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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 au...

Medicare Advantage Evaluation Requires Transparent Claims Data

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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, ProP...

96% of Payers Are Committed to Electronic Prior Authorization

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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 Ado...

NCQA Seeks Stakeholder Comments on Updated HEDIS Measures

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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 p...

How All-Payer Claims Databases Can Identify Wasteful Spending

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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 re...

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

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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 b...

VA Awards Accenture $62M Benefits IT Infrastructure Contract

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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) will ...

Payers, Providers Pledge to Improve Prior Authorizations

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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 c...

All-Payer Claims Databases Offer Insights into Healthcare Spending

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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 avoidable. State-l...

How Payers Can Streamline Prior Authorization for Prescriptions

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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 vali...

Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

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Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and Women&rsquo...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

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Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found.   After reviewing fraud preve...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

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Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared a ...

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