Medicaid and CHIP

November 21, 2014 | Anthony Brino

The Medicaid private option policies designed to insure low-income individuals through a more market-based system is showing early signs of success, but also hurdles.

November 6, 2014 | Anthony Brino

Federal officials are preparing the first major regulatory update to Medicaid managed care in a decade, promising to challenge insurers but also fix long-standing issues and offer routes to business standardization.

November 5, 2014 | Anthony Brino

How will a long-time insurance manager fix the crisis in a state with some of the most expensive and advanced healthcare on the planet?

October 8, 2014 | Anthony Brino

Insurers with Medicaid managed care plans can breathe one big sigh of relief, but there are still other things with the insurance fee in Medicaid to worry about.

October 7, 2014 | Mary Mosquera

Insurers that manage long-term care and supports for individuals with disabilities in their home or community will have to assure that beneficiaries can interact with their community and make more of their own life choices.

October 6, 2014 | Anthony Brino

In the many quests for sound Medicaid reimbursement, healthcare provider advocates may soon have another tool to compel state governments.

October 3, 2014 | Mary Mosquera

Health plans, providers and legislators need to increase the number of primary care practitioners participating in Medicaid as the wait for many to access care is inadequate and getting worse as enrollment mushrooms.

September 26, 2014 | Anthony Brino

The ranks of Medicaid are reaching record levels, giving payers and providers, especially, new opportunities.

September 22, 2014 | Anthony Brino

With enrollment at an all-time high and only increasing, state Medicaid programs and the health plans they contract with need to prioritize a few key areas of the beneficiary experience.

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.

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.

June 19, 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 19, 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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