Medicaid and CHIP

September 15, 2014 | Anthony Brino

Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies.

September 9, 2014 | Anthony Brino

Healthcare advocates for seniors are trying to stop a managed care expansion for the country's largest Medicare-Medicaid dual eligible population, in what could be a precedent for other states.

September 2, 2014 | Anthony Brino

Another state is being offered a federal waiver to expand Medicaid on its own terms, hoping to bring the efficiency of private insurance and new value incentives to the public payer program.

August 27, 2014 | Michelle Andrews

The federal government is ordering state Medicaid programs to pay for comprehensive autism services, but some details remain unclear.

August 19, 2014 | Anthony Brino

Oregon is mandating Medicaid coverage for gender dysphoria treatment, bringing it in parity with the state's progressive commercial market and also putting pressure on other states and insurers.

August 11, 2014 | Anthony Brino

Of all the health organizations working as Medicaid managed care plans, a good number of provider-based plans are thriving, sometimes in places where traditional Medicaid HMOs are not.

August 8, 2014 | Erin McCann

One state is finding new approaches to managing Medicaid frequent fliers.

August 6, 2014 | Anthony Brino

At a time when states are both reforming Medicaid and expanding managed care, insurers have a lot of opportunities to grow business and increase value, but also many challenges.

August 4, 2014 | Anthony Brino

One of the largest Medicaid managed care expansions has been given the green light for what will be a test of reducing public-payer spending.

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.

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.


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