Medicaid and CHIP

July 24, 2014 | Anthony Brino

At a time when states are both reforming Medicaid and expanding managed care, insurers have a lot of opportunities but also face many financial pressures.

July 21, 2014 | Anthony Brino

After taking losses of $40 million over three years, BlueCross BlueShield of Western New York is withdrawing from the Empire State's Medicaid managed care program in six of its eight counties of operations.

July 15, 2014 | Anthony Brino

Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option.

July 14, 2014 | Anthony Brino

Amid record enrollment in Medicaid and state concerns about the program's budgetary sustainability, the federal government is offering new financial support and policy options.

July 7, 2014 | Anthony Brino

As the final chapter of WellCare's fraud saga closes, the company is lining up new executives and trying to grow.

June 23, 2014 | Anthony Brino

Even before federal approval is won for the experimental program, insurers in one large state are ready to start selling exchange plans to Medicaid beneficiaries.

June 18, 2014 | Anthony Brino

The state of Illinois is nailing down key Medicaid policies ahead of a massive managed care rollout and accountable care experiment.

June 17, 2014 | Anthony Brino

A health plan and a health system are preparing for the rise of capitation in Medicaid with a new care management venture, as more state programs try to phase out fee-for-service.

June 12, 2014 | Anthony Brino

Healthcare companies working for publicly-funded programs have one certainty: they will be serving many more Americans getting public coverage, at the same time they will have to bring down the cost-curve.

June 11, 2014 | Richard Pizzi, Editorial Director

If your state is building a health insurance exchange, or you hope it ultimately will, the experience of Washington, Kentucky and Minnesota can help.

June 5, 2014 | Anthony Brino

As Medicaid enrollment grows to record levels, covering 65 million people nationwide, providers are starting to see some positive trends in their rates of uncompensated care, as managed care organizations garner new membership.

June 4, 2014 | Anthony Brino

As a once-promising tax scheme to maximize federal Medicaid dollars fades from practicality, budget woes are coming to the fore and creating an impetus for program redesigns.

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.

June 20, 2012 | White Papers
Insurers are efficiently and accurately paying millions of claims that they should never pay at all. In this white paper we define state-of-the-art prepayment analytic strategies and explain how they differ from both claims edit and postpayment detection systems.

June 20, 2012 | White Papers
In this case study, you’ll learn how Highmark dramatically reduced losses with a new analytic approach to preventing and detecting fraud, waste and abuse in submitted claims. Learn how this approach enabled Highmark to identify hundreds of new pursuable cases in the first year over and above cases identified through other methods.


Advertisement. Closing in 15 seconds.