Health plans and TPAs
Health plans are insurance policies that private companies or government programs offer to cover healthcare costs for enrolled individuals. Third-party administrators manage and process insurance claims for these health and employee benefit plans, often serving as intermediaries among healthcare providers, payers and beneficiaries.
Top Stories
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News
13 Dec 2024
High health costs force small employers to up cost-sharing
As small businesses struggle to keep up with rising healthcare costs, many have increased cost-sharing for their workers in both single and family coverage. Continue Reading
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01 Nov 2024
ACA open enrollment for 2025: What you need to know
CMS pursued proven outreach strategies for ACA open enrollment 2025, sought to lower costs for consumers, and announced that the number of ACA plans had increased. Continue Reading
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14 Feb 2023
The Role of Medicaid Managed Care Organizations in the PHE Unwinding
Medicaid managed care organizations can help mitigate the negative effects of the public health unwinding in a variety of ways. Continue Reading
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13 Feb 2023
ACA Marketplace Plans Denied Nearly 17% of In-Network Claims in 2021
Claim denial rates varied among ACA marketplace plans offered on HealthCare.gov, with some issuers denying up to 49 percent of in-network claims. Continue Reading
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07 Feb 2023
Enrollment in Medicaid, CHIP Has Grown 28% During the Pandemic
The increased enrollment in Medicaid and CHIP may be attributed to states expanding Medicaid under the ACA and the continuous enrollment provision tied to the COVID-19 public health emergency. Continue Reading
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Answer
06 Feb 2023
The Future of Medicare Advantage Risk Adjustment Data Validation
Blue Cross Blue Shield Association, Humana, Avalere, and MedPAC address the impacts of the finalized Medicare Advantage Risk Adjustment Data Validation rule. Continue Reading
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06 Feb 2023
Medicare Advantage Plans Rejected 2M Prior Authorization Requests in 2021
Among the 212,000 denied prior authorization requests that were appealed, Medicare Advantage plans fully or partially overturned 173,000 of the denials. Continue Reading
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02 Feb 2023
Overview of the 2024 Medicare Advantage Advance Notice, Payer Reactions
The 2024 Medicare Advantage advance notice drew mixed reactions from payers, from concern about its technical complexity to support for quality measurement standardization efforts. Continue Reading
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01 Feb 2023
GAO: CMS Lacks Encounter Data for MA Supplemental Benefits
Confusion about CMS guidance and difficulties with procedure codes have led to limited encounter data for Medicare Advantage supplemental benefits. Continue Reading
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Answer
01 Feb 2023
How States Can Prepare for 2023 Medicaid Redeterminations
States face many challenges as the start date for Medicaid redeterminations approaches, but they can take steps before, during, and after redeterminations to mitigate major missteps. Continue Reading
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31 Jan 2023
HHS Approval Boosts Access to Care for Incarcerated Medicaid Beneficiaries
The section 1115 demonstration approval allows incarcerated Medicaid beneficiaries in California to receive healthcare services, such as substance use disorder treatment, before their release. Continue Reading
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30 Jan 2023
HHS Finalizes Medicare Advantage Risk Adjustment Data Validation Program Rule
The final rule aims to fix the flaws that have plagued the Medicare Advantage risk adjustment data validation program and that led to overpayment. Continue Reading
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30 Jan 2023
CMS Announces ACA Special Enrollment Period during PHE Unwinding
CMS introduced the special enrollment period to manage the potential for widespread confusion among disenrolled Medicaid beneficiaries when the continuous enrollment policy ends. Continue Reading
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27 Jan 2023
65% of Beneficiaries Were Uninsured After Medicaid, CHIP Disenrollment
Among beneficiaries who experienced uninsurance after disenrollment from Medicaid or CHIP, 17 percent were uninsured for the entire year and 33 percent re-enrolled in the public program by the end of the year. Continue Reading
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26 Jan 2023
Medicaid Expansion Tied to Reduced Postpartum Hospitalizations
In states that adopted Medicaid expansion, postpartum hospitalizations declined by 17 percent during the first 60 days after delivery and 8 percent between 61 days and six months postpartum. Continue Reading
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26 Jan 2023
2023 Affordable Care Act Marketplace Enrollment Breaks Historic Records
There were 16.3 million signups on the Affordable Care Act marketplace for plan year 2023, of which almost 3.5 million were new enrollees. Continue Reading
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24 Jan 2023
FCC Allows Use of Automated Calls, Texts for Coverage, Enrollment Info
Using automated calls and texts to communicate with beneficiaries about enrollment information may help minimize Medicaid coverage losses when the COVID-19 public health emergency ends. Continue Reading
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24 Jan 2023
The Role of Affordable Care Act Premium Tax Credits in the Payer Industry
Premium tax credits on the Affordable Care Act marketplace have influenced enrollment and access to care in the US for over a decade. Continue Reading
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23 Jan 2023
ACA Improved Access to Health Insurance for People with Schizophrenia
The share of people with schizophrenia without health insurance decreased from 8.4 percent to 4 percent after the Affordable Care Act was implemented. Continue Reading
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20 Jan 2023
Decreased Uninsurance Rate in 2021 Driven by Public Coverage Gains
Between January 2021 and February 2022, over 3 million people obtained Medicaid coverage, while another 4.7 million people gained insurance through other public coverage. Continue Reading
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18 Jan 2023
Medicaid Expansion Helped Reduce Eviction Rates, Housing Insecurity
States that expanded Medicaid with 1115 waivers and counties that had high eviction numbers before Medicaid expansion were more likely to see greater reductions in eviction rates. Continue Reading
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18 Jan 2023
US Uninsurance Dropped to 10.5% in 2021, Greater Equity in Coverage Gains
Experts attributed the decline in uninsurance to policies such as continuous enrollment and identified significant differences in coverage within racial categories. Continue Reading
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17 Jan 2023
Medicaid HCBS Recipients Had High Excess Mortality Rates During Pandemic
Excess mortality rates for Medicaid HCBS recipients under 65 were 26.6 times greater than the rate for the general population in 2020. Continue Reading
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16 Jan 2023
How State Medicaid Programs Address the Behavioral Health Workforce Shortage
Over 70 percent of state Medicaid programs reported at least one strategy to incentivize provider participation in Medicaid, helping to alleviate the behavioral health workforce shortage. Continue Reading
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13 Jan 2023
HHS Posts Timeline for Medicare 2026 Drug Price Negotiations
Drug price negotiations will begin officially on February 1, 2024 and will run through August 1, 2024 and federal agencies will seek public comments prior to finalizing the negotiation process. Continue Reading
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12 Jan 2023
CMS: 15.9M Enrollees Have Selected ACA Marketplace Plans for 2023
Almost 12 million enrollees have chosen an ACA marketplace plan through HealthCare.gov, while 4 million have signed up for coverage in state-based marketplaces. Continue Reading
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12 Jan 2023
Medicare Advantage Beneficiaries Have Better Diabetes Patient Outcomes
Medicare Advantage beneficiaries may see receive chronic disease management for their diabetes than fee-for-service Medicare. Continue Reading
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11 Jan 2023
HHS, CMS Guidance Boosts Access to Specialty Behavioral Healthcare
The guidance allows Medicaid and CHIP agencies to reimburse consulting and treating practitioners for providing specialty behavioral healthcare to beneficiaries. Continue Reading
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09 Jan 2023
LA Care Health Plan Grants $2M to Address Provider Burnout, Shortages
Fourteen physicians will receive medical school loan repayment grants as part of the payer’s initiative to address provider burnout and increase workforce retention. Continue Reading
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06 Jan 2023
High Perceived Healthcare Costs Limit Coverage Access for Uninsured
Nearly two-thirds of uninsured individuals thought the monthly cost of health insurance would be between $50 and $500, indicating how high perceived healthcare costs limit access to coverage. Continue Reading
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05 Jan 2023
156M Beneficiaries Receive Health Insurance Through Public Programs
As of September 2022, public programs provide health insurance coverage to 156 million beneficiaries, including 65.1 million people who are enrolled in Medicare and 90.9 million people who are enrolled in Medicaid and CHIP. Continue Reading
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05 Jan 2023
OIG: Cigna Should Refund Feds $5.9M for Medicare Advantage Overpayments
As part of its audit of Medicare Advantage overpayments, OIG found that Cigna-HealthSpring of Tennessee raked in around $5.9 million in federal funding for inaccurate diagnoses. Continue Reading
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03 Jan 2023
Traditional Medicare to Medicare Advantage Switching Rates Grew in 2020
In 2020, 6.8 percent of beneficiaries switched from traditional Medicare to Medicare Advantage compared to 2 percent of beneficiaries who shifted from the private to the public program. Continue Reading
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29 Dec 2022
Affordable Care Act Marketplace Enrollment Up by 1.8M From Last Year
The Inflation Reduction Act expanded premium tax credits for three years, helping to boost access to low-cost health plans as Affordable Care Act marketplace enrollment grows. Continue Reading
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Feature
27 Dec 2022
Understanding the Different Metal Plans in the ACA Marketplace
The metal plans in the ACA marketplace are required to provide coverage for the same essential health benefits but differ largely by healthcare costs, including monthly premiums, deductibles, and out-of-pocket expenses. Continue Reading
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23 Dec 2022
Continuous Eligibility Policies Can Reduce Medicaid Churn Among Kids
In states with 12-month continuous eligibility policies, the Medicaid churn rate among children was 2.9 percent in 2017, compared to 5.3 percent in states without policies. Continue Reading
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20 Dec 2022
Public Charge Rule Led to Delayed Healthcare Among CA Immigrants
Low-income immigrants in California who avoided Medicaid and SNAP due to the public charge rule were twice as likely to delay healthcare services. Continue Reading
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19 Dec 2022
5 Considerations for Payers before Entering Dual Eligible Market
Payers that are considering entering the dual eligible market should consider changes that will arise due to the end of the Financial Alignment Initiative and other CMS and state policies. Continue Reading
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16 Dec 2022
BMA Shares How CMS Can Improve Medicare Advantage Program
As Medicare Advantage enrollment grows, sustaining and strengthening the private program is essential to improving care for beneficiaries, BMA said. Continue Reading
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13 Dec 2022
Number of Uninsured Children Declined by 210K During Pandemic
In addition to the number of uninsured children declining, the uninsurance rate among kids fell from 5.7 percent in 2019 to 5.4 percent in 2021. Continue Reading
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12 Dec 2022
3 Payment Integrity Strategies for Payers in 2023
Payers can look no further than their payment integrity practices to reduce provider abrasion, improve member experience, and free up resources for innovation. Continue Reading
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07 Dec 2022
PHE Expiration Will Lead to Medicaid Coverage Losses for 18M People
After the PHE ends and 18 million beneficiaries lose Medicaid coverage, an additional 3.8 million people are projected to be uninsured, while 9.5 million people will enroll in employer-sponsored coverage. Continue Reading
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06 Dec 2022
19 States Must Align Medicaid Vaccine Coverage Policies with IRA
Both fee-for-service programs and Medicaid managed care plans will have to review their Medicaid vaccine coverage policies. Continue Reading
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05 Dec 2022
Plan Value, Expected Care Use Drove ACA Consumers into Uninsurance More than Cost
Perceptions about plan value and healthcare use can push consumers toward uninsurance more than health insurance costs. Continue Reading
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01 Dec 2022
Proposed Rule May Prevent Coverage Losses for Dual Eligible Beneficiaries
Thirty-eight percent of dual eligible beneficiaries lost at least one month of Medicaid coverage within the year after enrolling in 2018, suggesting that the Medicaid eligibility proposed rule may reduce coverage losses. Continue Reading
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29 Nov 2022
NCQA Confers Health Equity Accreditation on Elevance Health Medicaid Plans
The payer’s Medicaid plans that received health equity accreditation represented a majority of Elevance Health’s Medicaid beneficiaries. Continue Reading
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28 Nov 2022
How Health Insurance Coverage Varies Across, Within Families
In two-adult families with and without children, the majority of members had the same type of health insurance coverage, whether they had group plans, non-group plans, or Medicaid. Continue Reading
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23 Nov 2022
Immigrants’ Premium Contributions Exceed Payer Spending on Care
Although immigrants and US-born citizens had similar premium contributions, payers spent 22.3 percent less on healthcare for immigrants than they did for US-born citizens. Continue Reading
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21 Nov 2022
Early 2023 Affordable Care Act Marketplace Enrollment Exceeds 2022 Trends
Enrollment on the Affordable Care Act marketplace is on track to surpass the record-breaking 2022 enrollment levels as early data outstrips the previous year’s performance. Continue Reading
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18 Nov 2022
62% of Adults Are Unaware of Medicaid Renewals Resuming Post-PHE
While most adults had heard nothing about upcoming Medicaid renewals, the 37 percent who had heard at least a little about the changes cited the media as their top source of information. Continue Reading
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14 Nov 2022
Top 4 Medicare Advantage Penetration, Access Trends in 2023 Open Enrollment
Medicare Advantage beneficiaries across the US have access to more Medicare Advantage health plan options in 2023 than in 2022, but other trends have remained consistent. Continue Reading
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14 Nov 2022
Medicaid Expansion Reduced Medicare Hospitalizations During Dialysis
In addition to reducing hospitalizations among Medicare beneficiaries with kidney failure, Medicaid expansion significantly decreased mortality rates 12 months after dialysis initiation. Continue Reading
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10 Nov 2022
ACHP Offers 5 Recommendations For CHIP, Medicaid During PHE Unwinding
ACHP had five suggestions for CMS regarding how to handle CHIP and Medicaid processes when the public health emergency ends. Continue Reading
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08 Nov 2022
OUD Treatment Coverage, Prior Authorizations Common in Medicaid FFS
Most Medicaid fee-for-service programs offered coverage for buprenorphine, methadone, and injectable naltrexone, but 47 percent imposed prior authorizations for the OUD treatments compared to 35.9 percent of Medicaid managed care organizations. Continue Reading
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08 Nov 2022
How AZ Medicaid Expanded Its Role in Social Determinants of Health Coverage
Arizona's Medicaid program took on an innovative role in addressing social determinants of health, particularly in housing. Continue Reading
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01 Nov 2022
2020 Medicare Open Enrollment Saw Low Rates of Plan Comparison
Comparing health plans should be a critical process during Medicare open enrollment season, but only a small share of Medicare beneficiaries engage in the activity. Continue Reading
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31 Oct 2022
Understanding the Cost of Ineffective Payment Integrity Operations
Improved payment integrity ensures that payers maintain strong relationships with providers and members while driving down administrative costs. Continue Reading
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28 Oct 2022
HHS: Over Half of States Have Extended Medicaid Postpartum Coverage
Georgia and Pennsylvania have joined 24 states and Washington, DC in extending Medicaid postpartum coverage from 60 days to a full year after pregnancy. Continue Reading
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27 Oct 2022
2022 Marketplace Enrollment Grew Significantly for Black, Latino Enrollees
The premium subsidies under the American Rescue Plan Act, increased Navigator funding, and expanded outreach helped drive 2022 marketplace enrollment gains for Black and Latino populations. Continue Reading
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27 Oct 2022
CMS Expects More Americans Will Qualify for Affordable Care Act Coverage in 2023
Ahead of the Affordable Care Act marketplace 2023 open enrollment period, CMS shared the various new opportunities for enrollment. Continue Reading
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26 Oct 2022
Outreach from State-Based Marketplaces Increased 2022 ACA Enrollment
Most outreach strategies from state-based marketplaces prioritized conveying information about the increased ARPA premium subsidies and offering linguistically appropriate communication. Continue Reading
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26 Oct 2022
Medicaid Directors Project 12.5% Total Medicaid Spending Growth in FY 2022
Medicaid spending growth is expected to escalate in 2022 before taking a dive in 2023 to a little more than four percent growth. Continue Reading
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25 Oct 2022
Medicare Advantage Contract Terminations Worsen Racial Health Disparities
Almost 22 percent of beneficiaries in terminated Medicare Advantage contracts were Black, compared to 14.3 percent of beneficiaries in non-terminated contracts, highlighting how contract terminations can impact racial health disparities. Continue Reading
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21 Oct 2022
Community-Based Orgs Can Help Manage Post-PHE Medicaid Coverage Changes
Community-based organizations can form advisory groups to gather feedback from beneficiaries and inform states of any questions or concerns regarding Medicaid coverage changes. Continue Reading
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20 Oct 2022
Personalized Phone Calls, Emails Boosted ACA Enrollment Rate in CA
While email reminders alone did little to improve enrollment, emails coupled with personalized phone calls increased the ACA enrollment rate by 47 percent for former Medicaid beneficiaries in California. Continue Reading
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20 Oct 2022
Brokers, Assisters Share Affordable Care Act Marketplace Consumer Trends
The brokers and assisters serve different populations, but found generally a lack of awareness around key insurance and Affordable Care Act marketplace topics. Continue Reading
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18 Oct 2022
Older Beneficiaries Choose Medicare Advantage for Enhanced Benefits
Nearly a quarter of beneficiaries over 65 chose Medicare Advantage over traditional Medicare due to the enhanced benefits the program offers, such as dental and vision coverage. Continue Reading
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13 Oct 2022
Healthcare Utilization Lower for MA Beneficiaries with Complex Care Needs
Hospital stay rates for Medicare Advantage beneficiaries with complex care needs ranged from 9.3 percent to 11.9 percent lower than rates for those in traditional Medicare, indicating less healthcare utilization. Continue Reading
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12 Oct 2022
Payers Alert Communities About Medicaid Redetermination Renewal
Community health plans can use a combination of community-level and individual outreach strategies to ensure that Medicaid redetermination does not result in high uninsurance. Continue Reading
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12 Oct 2022
How MN Medicaid Used Community Engagement to Address Health Disparities
Minnesota’s Medicaid program addressed health disparities and improved maternal health through community engagement initiatives that sought feedback from Black and American Indian beneficiaries. Continue Reading
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11 Oct 2022
MA, Part D Contracts See Lower 2023 Medicare Advantage Star Ratings
Medicare Advantage star ratings for Medicare Advantage-prescription drug contracts and Part D plans dropped compared to 2022 due to methodology changes and pandemic-related challenges. Continue Reading
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10 Oct 2022
SDOH, Nonmedical Supplemental Benefits Lacking for MA Dual Eligibles
Less than half of general Medicare Advantage plans and dual eligible special needs plans offered nonmedical supplemental benefits for dual eligible beneficiaries. Continue Reading
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30 Sep 2022
Report Finds Disparities in Children’s Health Insurance Coverage
Children’s health insurance coverage was less common among American Indian and Alaska Native kids, lower-income kids, and those between the ages of 12 to 17. Continue Reading
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30 Sep 2022
Top 10 Highest Performing Medicare, Medicaid Health Plans
The top highest performing Medicare and Medicaid health plans for 2020-2021 earned high marks in consumer satisfaction, preventive care, and treating chronic conditions. Continue Reading
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28 Sep 2022
CMS Approves MA, OR Section 1115 Demonstration Initiatives
The section 1115 demonstration initiatives sought to improve overall coverage in the states and address social determinants of health. Continue Reading
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27 Sep 2022
CMS: Medicare Part B Premiums, Deductibles Will Decrease in 2023
Monthly Medicare Part B premiums will fall to $164.90 in 2023, marking a $5.20 decrease from this year, while Part A premiums are set to increase by $4 to $7. Continue Reading
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27 Sep 2022
OIG: Medicaid Managed Care Plans Submit Incomplete MLR Reports
To improve the accuracy of Medicaid managed care plans’ MLR reports, CMS should ensure states are verifying the completeness and accuracy of the reported data elements, OIG said. Continue Reading
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22 Sep 2022
NC Hospitals Propose to Fund Medicaid Expansion, Reform CON Laws
In addition to reforming certificate of need laws, the proposal declared that hospitals would cover the state’s share of Medicaid expansion costs, which would amount to over $550 million per year. Continue Reading
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21 Sep 2022
Increasing Medicare Spending Calls For Short, Long Term Financing Solutions
The status of Medicare financing is complex, but with Medicare spending on the rise policymakers need to implement both short- and long-term solutions. Continue Reading
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21 Sep 2022
Uninsured, Publicly Insured Report Unfair Treatment in Patient Experience
Patient experience can vary based on coverage type and may result in unfair treatment for those with public payer coverage or who are uninsured. Continue Reading
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20 Sep 2022
How Do Medicare Advantage Plans Compare to Traditional Medicare?
Medicare Advantage beneficiaries were more likely to have a usual source of care and utilize preventive care services, but traditional Medicare beneficiaries experienced fewer cost-related problems. Continue Reading
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16 Sep 2022
States Plan Medicaid 1115 Demonstration Waivers for Incarcerated People
Various states submitted 1115 demonstration waivers to CMS, aiming to adjust guidance to improve Medicaid services among incarcerated patients. Continue Reading
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15 Sep 2022
Alzheimer’s Risk Adjustment Increases Detection, Medicare Spending
When using risk adjustment for Alzheimer’s disease and related dementias, Medicare had a 66.1 percent likelihood of correctly identifying positive cases, which could increase Medicare spending. Continue Reading
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12 Sep 2022
Public Charge Final Rule Published, Pursues Health Equity For Immigrants
The public charge final rule will go into effect in late December 2022 and seeks to reduce the impacts that public benefits usage can have on the immigration process. Continue Reading
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06 Sep 2022
Uninsurance, Medicaid Coverage Could Delay Colon Cancer Diagnosis
Not only could health insurance type impact colon cancer diagnosis, but distance from a treatment facility could also be a factor. Continue Reading
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02 Sep 2022
Middle-Income Seniors Will Struggle to Afford Paid Caregiving in 2033
While many middle-income seniors will not be able to live without paid caregiving, financial barriers will prevent many from finding support. Continue Reading
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30 Aug 2022
48% of Medicare Beneficiaries are Enrolled in Medicare Advantage Plans
Most beneficiaries were enrolled in individual Medicare Advantage plans, but 18 percent of members were in employer-sponsored group plans and 16 percent were in special needs plans. Continue Reading
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30 Aug 2022
HHS, CMS Bump Affordable Care Act Marketplace Navigator Funding
The nearly $100 million dollar boost to the Affordable Care Act marketplace Navigator program’s funding follows on the heels of the historic funding increase in 2021. Continue Reading
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29 Aug 2022
15M Beneficiaries Will Lose Medicaid Coverage When PHE Ends
Just over 8 million beneficiaries will lose Medicaid coverage due to a loss of eligibility, while 6.8 million will maintain eligibility but lose coverage due to administrative churning. Continue Reading
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29 Aug 2022
Large Dialysis Facilities Bumped Prices for Major Medicare Advantage Plans
Medicare Advantage plans paid higher prices for in-network dialysis treatment than fee-for-service Medicare. Continue Reading
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29 Aug 2022
How Plans Simplify Payment Integrity by Choosing the Right Partner
Payers can facilitate greater efficiency in their payment integrity efforts by choosing a single strategic partner and leveraging a single data stream. Continue Reading
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26 Aug 2022
VA Medicaid Expansion Lowered Member Financial Concerns During COVID-19
Virginia’s Medicaid expansion may have helped lessen the financial impact of the coronavirus pandemic and improved health equity. Continue Reading
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24 Aug 2022
State Medicaid Programs Boosted HCBS Waiver Adoption for Senior Care
State Medicaid programs increased their home and community-based service waivers for seniors leading up to the coronavirus pandemic. Continue Reading
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23 Aug 2022
CMS Proposes Reporting Requirement for Medicaid, CHIP Quality Measures
The reporting requirement applies to Medicaid and CHIP quality measures that assess children’s healthcare, adult behavioral healthcare, and Medicaid’s health home benefit. Continue Reading
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18 Aug 2022
Private Sector Outreach Did Not Make Up For Navigator Program Funding Cuts
Navigator program federal funding cuts impacted outreach to enrollees about their options on the Affordable Care Act marketplace, Medicare, and Medicaid. Continue Reading
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17 Aug 2022
HHS, CMS Approve Extended Medicaid Postpartum Coverage in 3 States
Nearly 35,000 people in Hawaii, Maryland, and Ohio will be eligible for Medicaid postpartum coverage for a full year after childbirth. Continue Reading
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11 Aug 2022
States See Patient Experience Shifts in the First Year After Medicaid Expansion
After Medicaid expansion, states saw changes in the composition of the Medicaid population and in patient experience, though some of these changes were temporary. Continue Reading
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02 Aug 2022
Medicaid Health Home Benefit Covers Children with Complex Conditions
The Medicaid health home benefit will start serving children in October 2022, as states seek to expand support for beneficiaries with complex needs. Continue Reading
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28 Jul 2022
Growth of ACA Maximum Out-of-Pocket Limits Exceeds Wage Increases
Between 2014 and 2023, ACA maximum out-of-pocket limits will have increased by 43 percent, while enrollee wages will have risen by 31 percent. Continue Reading
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27 Jul 2022
ACA Preventive Care Coverage Requirement Boosts Access to Care
A pending lawsuit in the Northern District of Texas seeks to overturn the ACA’s preventive care coverage requirement, threatening access to care for millions of Americans. Continue Reading
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25 Jul 2022
Why Payers Need to Modernize the Claims Payment Experience
Manual, outdated processes are creating inefficiencies and administrative burdens for healthcare payers. An integrated, multi-modal solution can overcome these challenges and modernize the claims payment experience. Continue Reading
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22 Jul 2022
52% of OR Medicaid Providers Never Saw Medicaid Enrollees in 2018
At least half of Oregon Medicaid providers were a part of the “phantom network”—providers that are listed on the Medicaid provider directory but never saw Medicaid enrollees. Continue Reading