Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

Data Analytics Key for Strengthening Employer-Payer Relationship

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Health insurance companies, employers, and the workforce take a number of different steps to ensure that the best decisions are made in terms of health plan policies and covered benefits. For a variety of reasons, some businesses choose employer-sponsored...

High-Deductible Health Plan Consumers Seek Price Transparency

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Families and individuals who have purchased healthcare coverage on the ACA health insurance exchanges may have seen that monthly premium rates are expected to rise 25 percent in 2017, but should be aware that those eligible for tax subsidies...

Top 4 Best Practices for Transitioning to Value-Based Care

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With the healthcare industry continually reforming toward better patient outcomes and reduced medical spending, health insurance companies have been moving away from fee-for-service payment structures and adopting value-based care reimbursement...

Misalignment of Healthcare Quality Measures Impacts Payers

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In the healthcare industry’s move toward value-based care reimbursement, public and private payers create healthcare quality measures meant to align with how providers are paid and what type of financial penalties will be instituted for...

MA Proposed Rule May Cut Savings from Ambulatory Surgery Centers

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New proposed changes to current legislation from the Massachusetts Department of Public Health may either decrease the use of or potentially eliminate ambulatory surgery centers, according to a press release from Healthcare Bluebook. The reason...

Health Insurance Marketplaces Call for Plan Standardization

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Healthcare payers are being instructed to offer standardized plan and benefit designs as the  federally facilitated health insurance marketplace is working to improve consumers’ ability to compare varying health plans during the next...

4 Ways Health Payers Could Decrease Medical Spending Growth

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Health insurance companies are often looking for key methods and best practices to reduce rising healthcare costs. Payers could avoid the continual increase in medical spending by reducing the rates of unnecessary and duplicative services, adopt...

Top Three Ways Health Information Exchange Benefits Payers

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When health payers and providers utilize health information exchange, they will make significant gains in reducing healthcare spending, reducing duplicative testing and services, and improving their use of preventive medical services, according...

Why Health Insurance Claims Should Include Medical Device UDIs

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More and more healthcare associations have been emphasizing the need to incorporate unique device identifiers (UDIs) from medical devices within health insurance claims. In fact, professionals from The Brookings Institution have spoken in favor...

Consumer-Driven Health Plans Reduce Medical Care Utilization

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The Health Care Cost Institute released new findings that show consumer-driven health plans are leading individuals to utilize less medical care as well as spending more on out-of-pocket costs. Among consumer-driven health plans, enrollees spend...

Lack of Price Transparency Leading Employers to Self-Insure

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Some employers are finding it difficult to keep contracting with their health payers due to continually increasing monthly premium costs and a general lack of price transparency across the health insurance industry. As such, the notion of a company...

7% of Counties Retain One Payer on Health Insurance Exchanges

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With more health payers such as UnitedHealthcare, Humana, and Aetna dropping out of a number of state health insurance exchanges, it is useful to analyze the differences of healthcare coverage between different regions and states around the country....

New York, California Enact Rulings Against Surprise Medical Bills

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Healthcare payers may find that they may no longer have to pass on extraneous costs to their consumers when out-of-network providers send more costly claims their way. New legislation in states like New York and California may soon put an end...

Top 3 Ways Payers and Providers Can Reduce Claim Denials

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When it comes to medical claims management, healthcare payers and providers will need to communicate more effectively so that both parties are on the same page when it comes to claim denials. Healthcare payers should know that communication is...

4 Motives Why Hospitals Adopt Provider-Sponsored Health Plans

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Due to the many new transformations taking place within the healthcare industry today such as the transition from fee-for-service reimbursement to value-based care payments, the potential for creating provider-sponsored health plans has grown...

Cigna Boosts Outcomes Despite Affordable Care Act Obstacles

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With many health payers experiencing significant challenges while operating through the health insurance exchanges and adhering to various provisions of the Patient Protection and Affordable Care Act, it grows more important than ever before...

Payers Could Boost HEDIS Quality Measures by Exchanging Data

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HEDIS quality measures are managed by the National Committee for Quality Assurance (NCQA), which allows consumers to compare the quality of health plans among more than 90 percent of health payers around the country. HEDIS quality measures require...

Price Transparency Key Issue Among Health Payers and Employers

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The movement toward price transparency is gaining strength as healthcare reform continues to stress consumer and patient satisfaction. Employers have been seeking ways to improve price transparency for their employees when working with partnering...

Trial Date Set for Aetna-Humana Health Insurance Merger

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Health insurance companies and private physician practices or hospitals have often been on opposite sides of the fence when it comes to operating their organizations and managing their patient base. The typical stereotype is that payers and providers...

Top 3 Predictions for Health Insurance Industry News in August

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The future of the health insurance industry changes depending upon the regulatory challenges happening at a particular time as well as consumer interests and provider needs transforming the healthcare landscape in today’s transitioning...

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