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October 8, 2014 | Anthony Brino

In a new market for western Pennsylvania healthcare lives, Highmark and UPMC are finding old disputes lurking, adding to consumer confusion amid a new product launch and open enrollment.


October 3, 2014 | Anthony Brino

Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand.


September 18, 2014 | Anthony Brino

Struggling Medicare Advantage and Part D drug plans are being given a last minute reprieve, although they will need to show more improvement if they want to stay alive longer than a year.


September 10, 2014 | Anthony Brino

Health reform is creating a new impetus for regional payers and providers to collaborate on long-standing problems. Medicare is proving to be a good place to start.


August 18, 2014 | Anthony Brino

Among providers trying to get into the insurance game, some are starting off small at the local level, but in a big, growing market segment.


August 12, 2014 | Anthony Brino

Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.


August 7, 2014 | Anthony Brino

Federal health officials are increasingly scrutinizing Medicare Advantage risk adjustment, suggesting policy changes and even clawbacks to come.


July 29, 2014 | Anthony Brino

Lawmakers, taxpayers and health organizations concerned about Medicare's sustainability can breathe a small sigh of relief, if not hold their breath.


July 28, 2014 | Anthony Brino

Incorporating federal sequestration into Medicare Advantage provider reimbursement has spurred a new lawsuit, and one that could spell trouble for other plans.


July 15, 2014 | Anthony Brino

Evidence from recent federal enforcement actions suggest pharmacy benefit managers are exposing public-payer managed care plans to problems that could send shivers up executive's spines.


May 29, 2014 | Anthony Brino

Medicare Advantage insurers may soon find themselves facing new public scrutiny over potential spending and overpayment discrepancies.


May 27, 2014 | Anthony Brino

The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled.


May 19, 2014 | White Papers
If your organization enters or changes data manually, or is using a series of macros cobbled together to automate enrollment, claims reprocessing, or panel updates, you’re probably losing time, money, and risking data quality. This study explores the causes, prevalence, and repercussions of these traditional data practices for payers, then shares innovative ways to conquer inefficiency with automation technology.

November 22, 2013 | White Papers
This case study reveals how one Medicare Advantage health plan boosted its productivity during AEP by 102% and grew its membership by 40% while reducing staff. Learn best practices that include broader automation, increased accuracy and compliance, and instant eligibility verification that will enable your organization to experience a new level of operational efficiency and productivity during the next annual enrollment period.

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.

April 4, 2013 | White Papers
Accountable care offers the nation’s ailing health care system new hope — but it isn’t a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer™ Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

April 4, 2013 | White Papers
This case study profiles a struggling Medicare Advantage business responsible for 11,600 lives in the southeastern United States. Lumeris recommended that the client implement the Collaborative Payer™ Model, an approach to improving clinical and cost outcomes via a strong payer-provider relationship. The company guided the client through a three-phase approach to develop this model, achieving outcomes including: earning appropriate revenue, reducing unnecessary utilization, improving quality metrics, and improving cost outcomes.

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.

WEBINARS AND WHITE PAPERS

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