Third Party Administrators

April 10, 2014 | Anthony Brino

Many startups and companies from other industries have physicians, hospitals, insurers and medtech manufacturers in their sights, betting that they can offer better services at cheaper prices for dissatisfied consumers.

April 1, 2014 | Anthony Brino

A long-time investment banker will be Humana's next CFO, the second recent executive hire from outside the health insurance industry brought in to help with an integration and retail strategy.

March 25, 2014 | Anthony Brino

With a new study of Independence Blue Cross members, evidence on the effectiveness of the patient-centered medical home is swinging back towards the positive.

March 25, 2014 | Anthony Brino

Aetna has won a huge state contract in Texas, pulling away 415,000 lives from Blue Cross Blue Shield and with them several billion dollars in revenue.

March 14, 2014 | Anthony Brino

With a banner of its logo draped over the New York Stock Exchange on the Friday before St. Patrick's Day, Castlight Health went public, in another sign that reducing friction and opacity in healthcare is sparking a gold rush of sorts.

March 13, 2014 | Anthony Brino

Depending on the outcome of a lawsuit Cigna is pursuing in Los Angeles, more out-of-network providers may be able to offer patients discounts while billing health plans in full.

March 7, 2014 | Anthony Brino

Humana is naming a healthcare outsider as its next chief innovation officer, just as executives are looking for breakthroughs from recent acquisitions.

February 26, 2014 | Anthony Brino

After the Health and Human Services Department gave a tentative go-ahead for some hospitals to help pay for health plan costs and an uproar ensued over funding for HIV/AIDS patients, Blue Cross and Blue Shield of Louisiana is planning to stop accepting premium payments from most third parties.

February 18, 2014 | Anthony Brino

And then there were three: Pennsylvania will have one fewer Blue Cross company if Highmark's latest deal is approved by state regulators.

February 5, 2014 | Anthony Brino

Liberty Mutual has won a reprieve from complying with Vermont's mandated health insurance claims reporting, a victory that may extend self-funded plan preemption to a range of state regulations.

February 5, 2014 | Anthony Brino

Humana is starting the year posting a fourth-quarter loss, preparing for Medicare Advantage reductions and worrying a bit about commercial risk pools. But with revenue growing, the company is banking on an integrated insurance and care model.

January 24, 2014 | Anthony Brino

Humana is being sued by an individual policyholder claiming he has been unable to cancel the plan despite months of trying, in what may be first such lawsuit over insurance company practices during the transition to ACA-compliant health plans.

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.

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.

June 6, 2012 | White Papers
This paper examines why health care reform is causing a shift to a consumer-driven business model and the role analytics plays in helping organizations make the transformation successfully. Read this white paper to gain insight on how health insurance plans can come out ahead with advanced customer intelligence and engagement strategies.

December 19, 2011 | White Papers
Although the health insurance industry has undergone significant changes over the past few years and continues to evolve at a rapid pace, now is the time to begin preparing for growth. And, with statistics showing that the member experience has not significantly improved in the last five years, it should move to the top of the list of “growth enablers”. Download this whitepaper to discover the eight steps health plans can apply to optimize the quality of the member experience.

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