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Regulatory Highlights that Health Plans Should Know
The Patient Access API and the Provider Directory API will be enforceable on July 1, 2021. HealthEdge is confident that we will have our standardized data requ…
Imagine an expectant mother has high blood pressure and sees a specialist. After the visit, the provider submits the claim to her insurance plan, and from ther…
Health Plans Bring Innovation to The Forefront In Strategic Planning
With the rise of telehealth and virtual care, innovative ideas are getting a big push forward in 2020.
I recently moderated a webinar with HealthEdge …
Provider Satisfaction: A Consistent Pain Point for Health Plans
Just about every health plan that I have talked to in my career is currently experiencing, or has had experienced, problems keeping their provider population a…
As Medicare Advantage Grows in Popularity, Health Plans Must Meet Market Demands
According to Medpac, the country's baby-boom generation (born between mid-1946 and 1964) began aging into Medicare in 2011 at a rate of about 10,000 peopl…
IT Leaders Agree: For Successful Investments, Align Tech and Business Goals
Technology, especially next-generation technology, plays a massive role in allowing health plans to embrace change, innovate, and remain competitive. However, …
Many factors can impact the claims payment process. With so many legacy solutions still present in the market, there is significant opportunity for inefficient…
Health Plans See Positive Results With Value-Based Care Reimbursement
Value-based reimbursements have been much debated since both houses of Congress overwhelmingly passed the Medicare Access and Children’s Health Insurance Progr…
The Importance of Patience and Understanding in the Payer Industry
Regional non-profits and health plans wholly owned by hospital systems may be facing challenges in the market today, especially considering COVID-19. Analytics…
Transparency in Coverage Final Rule and Other Regulatory Highlights Health Plans Need To Know
Transparency in Coverage Final Rule
On October 29th, the Transparency in Coverage Final Rule was released and will be published in the Federal Register. We …
For claims and pricing teams, managing fee schedules can be a massive headache.
With Medicare undergoing major quarterly updates as well as policy adjustme…
I know regulations can seem overwhelming, but if you look beyond checking the boxes to ensure compliance, there is so much opportunity. I always try to remind …
