As health plans grapple with rising expenses and heightened post-pandemic demand, a robust coordination of benefits…
Category: News
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…
Recovering improper costs in SNF and IRF claims
Claims related to long-term care are complex. Members who require long-term care typically face a variety…
Webinar: Lessons learned from a successful prepay FWA program
As health plans increasingly adopt formal prepay fraud, waste, and abuse (FWA) programs, many still face…
Decoding the HEDIS MY 2025 Technical Specifications
After holding a public comment period earlier this year, the National Committee for Quality Assurance (NCQA)…
Partnering for success in 3 critical areas of risk adjustment
Health plans that participate in risk adjustment understand the importance of accurate and timely data on…
Webinar: Decoding the 2025 Star Ratings
Every October, the Centers for Medicare & Medicaid Services (CMS) publishes the annual Star Ratings for…
Webinar: Key updates to improve coding accuracy in 2025
Improving coding accuracy is a key priority for risk adjustment leaders to drive value for their…