The Independent Dispute Resolution (IDR) ruling within the No Surprises Act oversees the mediation process between payers and out-of-network providers when they cannot agree on reimbursement. The Centers for Medicare
The Centers for Medicare & Medicaid Services (CMS) recently released a Request for Information (RFI) for the Advanced Explanation of Benefits (AEOB) requirements of the No Surprises Act.
Traditionally, provider directories have been maintained by individual health plans. These directories include a list of providers in their network along with information on address, name, phone
The healthcare network, made up of providers and managed by payers, is one of the most important aspects of the entire industry. It forms the
Maintaining correct and up-to-date provider credentials is critical for payers to effectively verify trusted practitioners. Poor provider network management can lead to penalties from federal
To combat the rising rates of chronic illnesses and related expenditures Medicare beneficiaries are required to complete a comprehensive health risk assessment (HRA) that serves
Third-Party Administrators (TPAs) and health plans have many things in common, but one that stands out is the challenge both are facing in today’s healthcare
More than 45 percent of American adults say it’s difficult to afford health care, according to a survey by the Kaiser Family Foundation. With the current healthcare
Accessibility and adequacy are two of the most important elements for healthcare plans today, and digital transformation has made both easier to track and provide.
There are several factors to consider when selecting a cost containment solutions partner. This includes cross functionality, customer concentration, and cost burdens. Continue reading on
