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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 …
Health plans face financial decisions every day that impact their bottom line. What terms will make a new provider contract more beneficial? How should a new p…
The alignment of business and technology, especially in this industry, is becoming increasingly important. To be successful, technology leaders must understand…
Keeping Information Secure Remains Top Of Mind For Health Plans
Security incidents that involve customer or member data are completely debilitating for a health plan’s business. On average, a data breach costs hea…
Challenge The Inefficient Status Quo In Claims Administration
Today, many health plans use homegrown or legacy systems that assume manual work as part of the process. With limited automation and integration, organizations…
Systems That Easily Integrate Necessary For Improving Claims Accuracy Rates
Once a health plan finalizes a claim, they do not want to go back and fix it retroactively. Claims accuracy rates improve productivity, reduce errors, and are …
So many regulations are intertwined; health plans cannot ignore the ones that may seem insignificant. Every year these smaller regulation changes get bigger.
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If an organization is open to change, it will always result in a successful, smoother implementation of new technology.
For those who are reluctant to chang…
As health plans continue to compete for membership, I have seen a shift in the market toward a focus on member-centricity. Health plans competing to aggressive…
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