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Claims Management News

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 Cigna and Anthem, according to a press release...

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 among physician groups and hospitals, according...

‘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 looking to engage with their provider to improve...

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 some commercial health plans. The two biggest...

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 scores allow health plans to determine where...

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 company press release. This report offers...

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 is a major aspect of this movement. Along...

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 Health Care Cost Institute (HCCI) released...

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 with the reforms taking place among payers...

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 the Health Care Cost Institute (HCCI) shows...

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 insists that the viewpoint claiming that healthcare...

$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 Healthline publication. The medical claims processing...

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 health insurance claims data to include medical...

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 and state regulators aiming at reducing healthcare...

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 together to reduce medical spending around...

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 industry. A report from J.D. Power called the...

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 while high-deductible plans are becoming more...

How One Health Payer Partnership Reduced Hospitalizations

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Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest over the next two years. The specific partnership...

Price Transparency May Lower $27 Billion in Healthcare

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Price transparency in the healthcare industry is becoming more and more pertinent and sought after. Research has shown that there is still insufficient price transparency within the medical field including hospital services. However, a new report...

How Health IT Automation Improves Consumer Satisfaction

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New technologies and health IT tools are becoming a necessary part of the health insurance industry, as innovative approaches like automation can largely benefit employees while portals could make a difference for health plan consumers. When...

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