Claims Processing

April 16, 2014 | Anthony Brino

Even with some 15 million Americans covered by high-deductible health plans, health organizations are "not prepared to meet consumer payment expectations," according to the fourth annual payment trends report by InstaMed, a Philadelphia-based billing management company.

April 7, 2014 | Anthony Brino

With about seven percent of all public and private health insurance claims paid incorrectly, insurers have a ways to go, beyond traditional models, if the healthcare spending crisis is to be reined in.

April 4, 2014 | Anthony Brino

As more employers seek to integrate workers compensation into benefits packages, a range of market trends and regulations are slowing what could be a natural fit.

March 31, 2014 | Anthony Brino

A group of chiropractors went to war with the Blues and it seems they’ve won, successfully using a novel legal theory that now has lawyers setting their sights on other large insurers.

March 28, 2014 | Anthony Brino

As the quality and cost transparency movements gain support within the healthcare industry, a more important question persists: what will actually work for consumers?

March 18, 2014 | John Andrews

The days of cryptic invoicing are coming to an end for healthcare, or at it least they should be, financial experts say.

March 5, 2014 | Anthony Brino

The parent company of some of the country's largest Blues plans appears to be shoring up cash reserves for what may one of the most unpredictable years in its history.

February 27, 2014 | Anthony Brino

As health systems around the nation buy up office-based physician practices and redub them outpatient facilities, Pennsylvania's largest insurer may be starting a competing trend with a new payment policy for one of the most profitable specialities.

January 31, 2014 | Joran Rau, Kaiser Health News

A study of autoworker claims found that hospitals with the highest prices tended to have the strongest reputations and tight holds on their local markets yet showed little evidence of providing better quality care.

January 13, 2014 | Mary Mosquera

Medical costs in commercial plans slowed between August 2012 and August 2013, according to the S&P Healthcare Claims Indices. Spending on inpatient, outpatient, and professional fees and pharmaceuticals all decelerated.

December 30, 2013 | Anthony Brino

The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.

November 19, 2013 | Anthony Brino

Among the biggest obstacles in getting health plan members to comparison shop is the popular notion that "you get what you pay for" — because it's actually true in most other industries.

March 25, 2014 | White Papers
Internal subrogation units can generate significantly more recovery dollars than those earned by using an external firm. This white paper outlines the steps to take to establish a well-run unit and find the right case management technology.

March 11, 2014 | White Papers
For health insurers, data integrity and visibility are key to successful integration with the Federal Marketplace. However, complex processes and trivial errors can lead to data gaps that impact revenue, profitability and member satisfaction. Adopting a standarized approach to data integrity early in the process is critical to succesfully adapting to the technologies and processes of the Affordable Care Act.

January 2, 2014 | White Papers
The healthcare industry struggles along the entire paper trail from start to finish. The current process is slow, costly, inefficient, full of errors, vulnerable to security breaches and hurts the people they are chartered to care for. Download this whitepaper and discover how DocuSign’s eSignature solutions modernize healthcare and life science organizations by eliminating paper and antiquated signature processes while meeting compliance requirements and reducing costs and errors.

November 20, 2013 | White Papers
Whether they realize it or not, most healthcare payers are losing millions of dollars each year across activities such as COB, subrogation, eligibility, MSP validation, and more. Fortunately, a new generation of "intelligent" cost containment solutions helps cut the losses and achieve significantly improved recoveries, cost avoidance, and increased revenue - all of which support health reform priorities such as medical loss ratio and waste and abuse efforts. This white paper details real-world examples of "intelligent" cost containment success, best practices for improvement, and more.

October 9, 2013 | On Demand Webinars
The healthcare sector is going through massive transformation. Payers have to invest in readiness around data delivery to federal and state or multiple health insurance exchanges before Jan 1, 2014 deadline. While the ICD-10 adoption deadline has been pushed back due to industry pressures on regulator - it is still a huge undertaking for any healthcare entity that touches diagnostic or procedural codes. These are just some of the projects that are converging on healthcare IT teams this year. For healthcare CIOs and IT teams and especially application development teams this project overload translates into a cascading capital and operational cost burden. Learn how Presbyterian reduced storage, operational costs and realized significant productivity benefits around critical business processes.

October 9, 2013 | White Papers
Healthcare reform is transforming the US medical insurance sector - creating a dynamic and competitive new market with compelling opportunities for growth. But do you have the necessary responsiveness to capitalize on these opportunities? Here are the five compelling ways technology investment delivers agility you need - and how.

September 23, 2013 | White Papers
Healthcare spending in the US is growing at an unsustainable rate, reaching 4.6 trillion dollars by 2020. For decades, health insurance has been a common benefit offered by employers, who have borne the majority of health plan premium costs. Many employers are adopting high deductible health plans to lower their own costs, causing employees to shoulder a greater financial burden. As a result of these high costs and game changing healthcare reform mandates, defined contribution healthcare models are emerging as a mechanism to drive increased choice for employees and increased cost control for employers. Explore the path to from defined benefit to defined contribution in this infographic.

September 23, 2013 | White Papers
In July 2013, Alegeus Technologies commissioned a research study among health benefit decision-makers at US employers to explore their awareness, understanding, and perceptions regarding defined contribution health benefit programs and private insurance exchanges. This Infographic illustrates the results of the survey, demonstrating how defined contribution and private exchanges represent a logical next step in the evolution towards a consumer-driven health benefit marketplace.

June 21, 2013 | White Papers
To run an effective and profitable pharmacy benefit management (PBM) company, core operations must be responsive and agile. If claims management, product delivery/fulfillment, price determination or client-pharmacy drug interaction services cannot continually be made more flexible and market-driven, the customer experience likely will suffer, negatively impacting profit margins. Learn how to reduce costs by improving automation, conflict rules management to overcome drug interaction conflicts, and manage rebates by leveraging rules.

May 1, 2013 | White Papers
The multimillion-dollar question is: Are you covering who you think you’re covering? This white paper gives insights into the scope of eligibility fraud among commercial managed care organizations, state employee health plans, and state and federal agencies. It also addresses why it is important to incorporate multiple, diverse data sources into your analysis to spot inconsistencies and anomalies. Lastly, read about five real-world case studies of eligibility fraud detection in action.

April 22, 2013 | White Papers
Sweeping changes that are underway in the healthcare industry will affect the way healthcare payer organizations do business. There are significant opportunities in the manual claims processing operation that may help you successfully navigate through these changes. This white paper explores the challenges payer organizations face in improving the manual claims process, how those challenges may be overcome, and the positive impact on the organization’s ability to manage through change successfully.

March 8, 2013 | White Papers
The Centers for Medicare and Medicaid Services announced in January that enforcement action for Phase I and II Operating Rules related to enhanced delivery and content of eligibility and claim status responses is delayed until March 31, 2013. This means you still have time to investigate solutions and reduce the risk of penalties to be assessed beginning no later than April 1, 2014. Are you ready? To learn more, download the RelayHealth Operating Rules Quick Start Guide.

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