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
Auto adjudication is the process of swiftly processing insurance and public benefit claims, without the need for manual intervention or decision-making for each claim. In essence, it’s about harnessing the
HCIM is excited to announce as of April 2024 we have partnered with Metamora Growth Partners, marking a significant milestone in our journey. This partnership presents an exciting opportunity for
Ensuring the payment process is accurate, efficient, and timely is crucial for healthcare payers. The SymKey Payment Processing Module is a tool to help streamline the check run process and
In a major move toward healthcare reform, the HHS along with the Departments of Labor and the Treasury have proposed provisions that address critical issues in the realms of prescription
Manual claims processing can be a costly, time-consuming process marred by potential errors. This is especially true for Durable Medical Equipment (DME) 10-month rentals, which are a complex but crucial
In a significant stride towards improved healthcare, the Centers for Medicare & Medicaid Services has unveiled its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) proposed rule. The comprehensive
For many payers, mundane tasks such as claim adjustments, recoupments, and retroactive changes are relegated to SQL scripts for the perceived benefit of freeing up more time in their examiner’s
In a recent appearance before the House Energy and Commerce Committee’s Subcommittee on Health, Centers for Medicine & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure spent some time shedding light on
The COVID-19 pandemic sent shockwaves through the healthcare industry, disrupting healthcare spending and utilization patterns, and leaving a noticeable impact on how we approach healthcare. Recent data from the Health
Maintaining Provider Data accuracy is one of the most common challenges for payers in the healthcare industry, and good reason. It can be overwhelming and, at times, very challenging to
Unexpected medical bills are a common issue that many patients face. In 2020, the Federal government passed the No Surprises Act to protect patients from these unexpected bills and increase
Health Plan Operations Health plan operations are complicated; increasing volume coupled with the demand for qualified claims professionals has made claims management in today’s world, difficult. Even beyond the demands
