Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Claims Management News

4 Key Ways Payers Could Reach HEDIS Score Thresholds

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Health payers looking to increase consumer satisfaction and member retention may need to reach care quality metrics and HEDIS measures. The National Committee for Quality Assurance (NCQA) is responsible for many aspects of HEDIS measures...

How Healthcare Payers Could Reduce Wasteful Spending

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For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and...

4 Ways Payers Could Improve Healthcare Price Transparency

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Healthcare price transparency remains a key issue for health payers across the country. In order to strengthen member retention efforts especially during open enrollment periods, payers will need to boost price transparency to improve...

How Payers Could Improve Population Health Management with Tech

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When payers transition their reimbursement structures toward a value-based care payment model, healthcare quality improvement needs to be addressed. In order to boost quality, payers could target population health management and data...

Key Ways Payers Could Improve Medical Claims Management

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Medical claims management is a key aspect of the payer-provider relationship. However, medical claims management tends to include multiple challenges for both payers and providers. Some of the problems stem from a lack of training in...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

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Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back...

Health Payer Solutions for Improving HEDIS Quality Scores

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Payers and providers transitioning to value-based care reimbursement need to commit to meeting and improving their HEDIS quality scores. However, the documentation involved in reporting HEDIS quality scores tends to become complex....

How Health Payers Could Help Reduce High Out-of-Pocket Costs

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A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant decrease in the uninsured rate around the...

Rise in High-Deductible Health Plans Requires Cost Transparency

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High-deductible health plans are becoming more and more common across the health insurance industry. With the many changes that the Affordable Care Act (ACA) has brought, payers are attempting to control costs by offering more...

Healthcare Payers Face Challenges with Medical Loss Ratio

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Under the Patient Protection and Affordable Care Act’s medical loss ratio, health payers are required to spend a minimum of 80 percent of their premium revenue on paying claims and boosting quality while the rest (20 percent) can be...

3 Key Steps for Health Payers to Meet HEDIS Quality Measures

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Health insurance companies are slowly moving toward adopting alternative payment models based on pay-for-performance metrics. This means more payers and providers are focused on meeting HEDIS quality measures. The scores payers receive on...

How Payers Could Use Price Transparency to Boost Satisfaction

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In order to reduce ever rising healthcare costs, health insurance companies will need to improve price transparency among their health plans as well as within their provider networks. The Robert Wood Johnson Foundation released a report...

How Provider Portals Streamline Medical Claims Management

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Healthcare payers have often struggled to process claims and provide effective customer service in a more streamlined manner due to technological inefficiencies. Insurers have faced challenges with engaging both their consumer base as well...

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...

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...

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...

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...

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...

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...

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,...

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