Addressing Commercial Health Plan Challenges to Ensure Fair ...

Health Care Payers COVID-19 Impact Assessment

America's multi-payer system spans an array of entities, including publicly financed programs (e.g., Medicare, Medicaid) and commercial insurers ...

FAIR Plan Improvements Are on the Way

As an organization representing community associations, we have long faced challenges in securing adequate insurance coverage due to outdated ...

Commercial Payer Coverage for Digital Medicine Codes | AMA

The AMA attacks the dysfunction in health care by removing obstacles and burdens that interfere with patient care. It reimagines medical ...

Addressing Health Care Market Consolidation and High Prices

... address challenges associated with the health care ... Traditionally, insurance commissioners have focused on ensuring health plan solvency and fair treatment of ...

Addressing Social Determinants of Health: Examples of Successful ...

Long-standing health inequities and poor health outcomes remain a pressing policy challenge in the U.S. Studies estimate that clinical care ...

Claims - The Health Plan

The Health Plan provides an in-process claims list on payment vouchers, a secure provider portal listing claims status, and a customer service area to handle ...

Filing a Claim for Your Health Benefits | U.S. Department of Labor

If you do not have a copy of your plan's Summary Plan Description or claims procedures, contact your plan's administrator, who is required to provide you with a ...

Insurance & Managed Care - Massachusetts Health & Hospital ...

Unnecessary insurance practices are adding costs to the healthcare system, imposing burdens on providers, and creating obstacles for patients seeking care. The ...

Streamlining the Medicaid, Children's Health Insurance Program ...

... plans that address specific State challenges. Our goal is to ensure ... insurance affordability programs, and provide advance notice and fair ...

HFS' Comprehensive Medical Programs Quality Strategy

The. State of Illinois' Business Enterprise Program is an integral part of addressing equity, and the goals of ... ensure that a health plan complies with the ...

AMA lawsuit targets collusion in health care pricing

A key element of that work is taking every step possible to protect the financial viability of the care physicians provide in a health care ...

The Strategy That Will Fix Health Care - Harvard Business Review

We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes ...

Health Affairs: Leading Publication Of Health Policy Research ...

November 2024 | G. Claxton, et al. Loss Of Public Health Emergency Funds Challenges The Financial Viability Of Nursing Homes, Especially Not-For-Profit ...

Addressing Social Determinants of Health Needs of Dually Enrolled ...

Despite the challenges related to treating dually enrolled beneficiaries, some MA plans that serve a high percentage of such beneficiaries still achieve high ...

Managing the Challenges of Paying for Gene Therapy - ICER

interconnected challenges must be addressed: determining a fair ... commercial health plans such as Elderplan, Driscoll Childrens Health Plan,.

Advancing Health Equity - CVS Health

At CVS Health®, we believe that everyone should have a fair and just opportunity to achieve optimal health. ... addressing challenges people face, including ...

Coordination of Benefits (COB): A complete guide - eHealth

... insurance providers to ensure claims are being processed, and address any delays promptly. Discrepancies in Benefit Payments: Challenge ...

Insurance Companies Reap Hidden Fees as Patients Get ...

It promises to help contain medical costs using fair and independent analysis. But a New York Times investigation, based on interviews and ...

42 CFR Part 438 -- Managed Care - eCFR

Contracts with MCOs, PIHPs, PAHPs, PCCMs and PCCM entities must provide as follows: (1) The MCO, PIHP, PAHP, PCCM or PCCM entity accepts individuals eligible ...

AI in the health insurance industry: An explainer and research roundup

Proposed state legislation and regulatory guidelines aim to require health insurance companies to be more transparent about how their systems ...