Claims Management News

Ambulatory Surgery Centers Decrease Costs by $38 Billion

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Health payers are often looking for ways to reduce healthcare spending, especially with regard to the costs of covering medical claims. Many have focused on implementing value-based care reimbursement...

29% of Doctors Have Tools Needed for Value-Based Care Payments

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While value-based care payments are making headway across the country, there are still barriers that stand in the way of payers and providers fully embracing these alternative payment models. A report...

Why Payers Should Adhere to Patient Engagement, Consumer Choice

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Consumer choice in health plans and provider networks is becoming a more popular topic of late among payers looking to increase patient engagement. There is a growing movement around the nation aimed...

Indiana, Florida Approve Anthem, Aetna Health Insurance Mergers

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The major health insurance mergers taking place between Anthem-Cigna and Aetna-Humana have shown some progress of late. Recently, the Indiana Department of Insurance approved the acquisition between...

Top 6 Factors for Success in Provider-Sponsored Health Plans

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The health insurance industry may have a complete transformation on their hands with regard to hospital and medical practice reimbursement. The number of provider-sponsored health plans is growing...

‘Data is Key’ to Cut Healthcare Spending, Boost Engagement

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A major goal among health payers today is to decrease continually rising healthcare spending. One way to do so is to identify patients who are at higher risk of deteriorating medical conditions and...

How State Policymakers Impact the Health Insurance Mergers

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In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as...

Key Ways Blue Cross Blue Shield Raises its HEDIS Scores

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The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of all health plans situated around the country to compare performance and year-to-year success. HEDIS...

Why Cigna Succeeds in Value-Based Care Reimbursement Model

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Earlier this month, the mobile technology company athenahealth released its annual PayerView Report, which delves into the complex and evolving relationship between payers and providers, according to a...

Why Payers Need to Address Patient-Centered Medicine

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The healthcare insurance industry needs to meet the demands of consumers looking for quality provider data. Patient-centered medicine is becoming a mainstay throughout the country and cost transparency...

Pediatric Care Out-of-Pocket Spending Rose 5.5% in 2014

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Both public and private health payers have been searching for ways to reduce healthcare spending as a whole, but rising prices may be making it more difficult to combat medical care expenditure. The...

13% of Midsize Employers Provide High-Deductible Health Plans

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The health insurance industry has been changing due to the Affordable Care Act and other regulatory pressures from the Centers for Medicare & Medicaid Services (CMS). Rising healthcare costs along...

Healthcare Cost Variation Differs Twofold between States

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Those who have spent time in a doctor’s office or emergency room may have seen that the prices of healthcare services tend to vary drastically among separate medical facilities. New findings from...

Is Rising US Healthcare Spending Burdening the Economy?

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Is healthcare spending in the United States too high? Are the financial aspects of running the medical system around the country burdening the US economy? The National Center for Policy Analysis...

$120 Million Settlement Ends Medical Claims Processing Failure

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One medical claims processing technological project has been put to rest in the state of California. This project began in 2007 and has still failed to be completed, according to the California...

Why Health Insurance Claims Data Needs Medical Device ID

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If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for...

Why Payers Should Improve Cost Transparency for Consumers

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The health insurance industry could benefit from greater cost transparency, as it could bring new methods for lowering healthcare spending and create a more competitive market among providers. Federal...

Could Electronic Processing Reduce Medical Spending Rates?

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The US healthcare system is one of the most expensive around the world and the rising costs haven't diminished significantly in recent years. Today, health payers and providers have been working...

Plan Member Satisfaction Reduced in Less Competitive Markets

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Due to the value-based care initiatives taking place at the Centers of Medicare and Medicaid Services (CMS), patient engagement and patient satisfaction have become imperative for the health payer...

How Data, Value-Based Care Drives Down Health Insurance Costs

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In today’s world, the average employee and business owner are seeing a rise in health insurance costs. Even through the health insurance exchange, premium prices are expected to rise this year...