Claims Processing

By Mike Miliard 11:10 am January 05, 2012
The TriZetto Group announced it has acquired Chandler, Ariz.-based Medical Data Express (MDE), with an eye toward expanding its managed solutions that serve more than 14 million Medicare Advantage and Part D members and more than 12 million Medicaid members.
By Diana Manos 10:40 am January 05, 2012
New standards for electronic funds transfers in healthcare, required by the Affordable Care Act, will reduce up to $4.5 billion off administrative costs for doctors and hospitals, private health plans, states and other government health plans over the next ten years, according to estimates included in new rules published today by the U.S....
By Diana Manos 11:14 am December 28, 2011
The Department of Health and Human Services, Office of the Inspector General, has identified 20 portable X-ray suppliers with "questionable billing patterns," according to a report issued Tuesday.
By Tom Sullivan 02:39 pm December 19, 2011
Department of Health and Human Services Secretary Kathleen Sebelius announced Monday the 32 health organizations that will take part in the Pioneer ACO initiative, striving for more coordinated care that could save up to $1.1 billion over five years.
By Mike Miliard 11:16 am December 19, 2011
Majorities of senior executives at U.S. hospitals, health systems and insurers are on the fence about their organizations' participation in the Medicare ACO program, according to a poll conducted by KPMG, law firm Epstein Becker Green and the JHD Group.
By Mike Miliard 10:34 am December 19, 2011
Letters of intent are due today from those interested in participating in the CMS Innovation Center's Health Care Innovation Challenge, which promises up to $1 billion for new ideas that improve care, shift incentives and help train a newly-focused healthcare workforce.
By Mike Miliard 10:33 am December 16, 2011
KLAS has unveiled its annual "Best in KLAS Awards" for software and professional services in 2011, ranking the best-performing healthcare IT vendors in more than 100 market segments based on ratings from over 18,000 interviews with healthcare providers.
By Mike Miliard 11:07 am December 06, 2011
Aetna on Tuesday announced results of a collaborative relationship with Connecticut-based primary care organization ProHealth Physicians, which since 2007 has made strides using information technology to improve quality of care and lower costs.
By Tom Sullivan 02:23 pm November 23, 2011
After a political impasse, in which Republicans effectively blocked his Senate confirmation, Donald Berwick, MD, will step down next week as administrator of the Centers for Medicare & Medicaid Services. President Obama has nominated CMS principal deputy Marilynn Tavenner as Berwick's replacement.
By Tom Sullivan 09:37 am November 22, 2011
The Centers for Medicare and Medicaid Services has its work cut out in transitioning to ICD-10. As the largest payer and the force driving the new code sets in the United States, CMS has a task at least as intimidating as anyone else when it comes to implementation.

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