Claims Processing

"Traditional risk-adjustment solutions have rapidly outgrown their retrospective-only payer use cases," Edifecs' CEO said.

In the 2022 plan year, new requirements for improving healthcare cost transparency and encouraging consumer engagement will take effect. Here's what you need to know about the new NSA member ID and Advanced EOB requirements.

The companies say they will use artificial intelligence and machine learning to digitize healthcare claims and improve the accuracy and timeliness of the process.

Aetna says it wrongly denied requests to cover fertility treatments for certain individuals and that it would rectify its mistake.

The Data Aggregator Validation program is aimed at ensuring the validity of clinical data and saving provider organizations time and money.

Two examples: It obtains denial information three to 14 days faster, and it has seen a 20% reduction in the number of employees supporting insurance-claims status workflows.

The new capability is aimed at employer-sponsored plans, building  on existing initiatives for UHC Medicare and Medicaid beneficiaries.

More than half of executives believe startups will lead the way in driving technology innovation, facilitated by government policies and regulations.

This week's top stories include UnitedHealthcare re-examining a policy that allows it to retroactively deny ER claims, Apple adding new health features and Mount Sinai catering to patients with limited English proficiency.

Providers will be able to send prior authorizations through Epic instead of using phone or fax.