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
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
