Technological advancements have the potential to transform healthcare, offering tools for better management and efficiency. However, a recent Senate report presents a critical view of how leading Medicare Advantage insurers
In recent years, healthcare providers have faced increasing challenges with claims denials, a trend that has worsened significantly since 2022. According to Experian Health’s 2024 State of Claims survey, the
The SymKey Solution SQL scripts have long been a staple in healthcare claims processing, managing everything from data updates to claims adjustments. Yet, they carry inherent limitations that can risk
At our recent 2024 All Colleague Meeting, the HCIM team came together to collaborate, celebrate, and take time to embrace the spirit of community and kindness. Our colleagues participated in
The 2024 updates to the Merit-based Incentive Payment System (MIPS) significantly impact healthcare professionals, influencing both management practices and compensation for Medicare Part B services. With eligibility criteria encompassing everything
Sequestration, a common hurdle for any healthcare payer under Medicare’s Fee-for-Service (FFS) program, often involves tedious manual processes. Let’s delve into this challenge and discover how SymKey frees you from
The launch of the Medicare Prescription Drug Inflation Rebate Program is a vital development for the financial and medical well-being of millions of Americans, specifically designed to ease the financial
The recent California Department of Health Care Services (DHCS) amendment to the AB 118 bill has Medi-Cal managed care health plans working overtime implementing this bill. This provision is increasing
North Carolina’s capital, Raleigh, played host to HCIM’s recent Leadership Team Meeting. In the midst of strategic discussions, the team took a meaningful detour to support the local community. Their
A leading ACO (Accountable Care Organization) and medical group manager faced significant challenges with its claims adjudication processes due to poorly designed auto-adjudication rules. These rules caused continuous claim cycles,
When faced with increasing claims volumes or special projects like large-scale reprocessing, many healthcare payers look to traditional solutions such as hiring more staff or mandating overtime for existing staff.
The COB Challenge Coordination of Benefits (COB) – the perpetual headache for healthcare payers. Manual processes, incomplete member questionnaires, and the eternal struggle of determining the order of benefits. The