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‘Gold Card’ Approach to Prior Authorization No Hurdle for HealthEdge
States have been passing legislation in recent years to address the complaints of providers that they are subject to too many prior authorization requirements …
A successful implementation of our products begins with a strong foundational relationship between our health plan customers and HealthEdge. Our goal is for cu…
Trends of 2022: Business Process as a Service (BpaaS)
An Intro to Business Process as a Service (BpaaS)
BpaaS is the delivery of business process outsourcing (BPO) services as a cloud-based subscription service…
Impacts of COVID-19 on Care Management in the Dual-Eligible Population
COVID-19 has highlighted weaknesses in our healthcare system and shone a spotlight on fault lines, especially for the most clinically and socially vulnerable l…
Within Medicare Advantage (MA), there are Special Needs Plans (SNP) with specialty cohorts that provide coverage for members who qualify for both Medicare and …
Why Using Modern Technology is Critical to Serving the D-SNP Population
As the dual eligible population grows, Dual Eligible Special Needs Plans (D-SNPs) are also experiencing tremendous growth across the country. CMS reports that …
Public Health Emergency Clock Ticks Forward to July
As expected, the Biden administration extended the mid-April expiration of the Public Health Emergency (PHE) another 90 days, so the countdown again restarts f…
In the ongoing struggle to achieve clarity around how Surprise Billing regulations will work, the Centers for Medicare and Medicaid (CMS) opened a Federal IDR …
Healthcare Rules and Regulations are Constantly Changing, But Your Payment Accuracy Doesn’t Have To
Healthcare is unique in so many ways – services are customized to each person, experience is impacted heavily by the provider, and quality of care is affected …
Health plan payers receive hundreds of millions of claims each year. With such an inundation, it’s easy to understand how complicated and challenging payment p…
Taming the Mess of Medicaid Payments Through Technology
Bad data is estimated to cost the healthcare industry $314 billion annually and negatively impact an organization’s revenue by 10-25%. The claims payment struc…
Value-based care aims to improve the quality and outcome for patients by linking provider reimbursement to the quality of care provided. Under this system, pro…
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