Payers face rising costs, increased post-pandemic demand, and growing expenses, leading to unfavorable medical loss ratios…
Category: News
Improving risk adjustment: Integrating internal and external innovations
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FWA Insights: Catching outlier behaviors in physical therapy claims
Fraud, waste, and abuse (FWA) significantly impact consumers by driving up healthcare costs, increasing insurance premiums,…
Busted: The top fraud schemes of Q2 2024
As we move through 2024, fraud, waste, and abuse (FWA) continue to be significant issues within…
Webinar: Decoding the HEDIS MY 2025 Technical Specifications
Three new measures, modifications to several existing measures, and various measure and indicator retirements are among…
Podcast: Star Ratings strategies for smaller MA plans
With the Centers for Medicare & Medicaid Services (CMS) recently deciding to recalculate the 2024 Star…
eBook: The three pillars of coordination of benefits (COB) success
As health plans grapple with rising expenses and heightened post-pandemic demand, a robust coordination of benefits…
Webinar: Engaging with members at the end of the year
As we approach the final quarter of 2024, both health plans and their members have many…
4 attributes of a successful specialty drug payment integrity program
Specialty drug claims are notoriously expensive and complex, comprising an estimated $243 billion of U.S. pharmaceutical…
eBook: How AI can drive health plan success
Payment integrity is an integral part of healthcare delivery, maximizing the value patients receive for their…