Claims Management News

How Can Health Savings Accounts Help, Hinder Patients and Payers?

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Health savings accounts (HSAs) have been widely discussed as lawmakers consider policy reforms, at the federal level, and have become a fixture in conversations about healthcare spending among payers...

What to Look for in Health Insurance Enrollment Technology

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Health insurance enrollment technology is designed to offer payers convenience, cost savings, and administrative ease-of-mind when it comes managing beneficiaries enrolled in health plans. Many...

Member Engagement for Payers Should Focus on Simplicity

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For payers, an effective member engagement strategy can lead to better member health, lower claims cost, and improved product loyalty.  To achieve these goals, payers should start by identifying...

ACA Risk Adjustment, Reinsurance Improved Payer Financials

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A new study published in Health Affairs found risk adjustment and reinsurance provisions of the Affordable Care Act improved financial outcomes for certain payers with higher risk enrollees....

Does Tiered Cost-Sharing Promote Appropriate Medication Use?

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Health plans have traditionally used tiered formulary cost-sharing arrangements to reduce healthcare spending and incentivize appropriate medication use. But a recent Journal of Managed Care &...

Joint Replacement Bundled Payment Cut Costs, Maintained Volume

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A new Altarum Institute study confirmed previous research that bundled payment models for lower extremity joint replacements decreased care costs without sacrificing care quality or substantially...

How to Develop HEDIS Quality Measures for Pediatric Care

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The American Academy of Pediatrics (AAP) announced yesterday on its website that it will be partnering with the National Quality Forum (NQF) to connect quality metrics to the interests of children and...

How to Reduce Obesity Rates, Increase HEDIS Quality Scores

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When attempting to improve provider performance on HEDIS quality scores, healthcare payers may need to pick and choose the quality measures that could be realistically raised. For example, childhood...

Why Payers Should Reduce Cost Sharing for High-Value Care

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Today, more healthcare payers are positioning greater cost-sharing onto the consumers to keep from raising premium rates, according to commentary published in JAMA Internal Medicine. The 2016 National...

How Payers, Providers Could Streamline Medical Claims Management

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Successful medical claims management and processing is not always easy to garner for health insurance companies due to a lack of training among insurance agents, missing or inaccurate...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...