Claims Processing

IPA, insurer launch innovative new partnership to manage social determinants of health
By Mike Miliard 03:19 pm August 07, 2019
Healthy Alliance IPA, led by former ONC deputy Dr. Jacob Reider, will work with MVP Health Care to connect social services and healthcare providers via the Unite Us technology platform. The aim: strengthening community organizations, boosting pop health and reducing costs.
John Muir Health outsources IT, revenue cycle, analytics and more to Optum
By Mike Miliard 10:41 am July 19, 2019
As part of the deal, which involves nonclinical technologies, about 540 health system staff will become Optum employees.
By Mike Miliard 03:41 pm July 18, 2019
The list of healthcare jobs the AHIMA Foundation program can help fill and upskill is long and varied, including clinical documentation improvement specialists, data analysts, medical and clinical lab techs, privacy and security officers and more.
Waystar snaps up prior authorization platform developer Digitize.AI
By Nathan Eddy 11:30 am July 12, 2019
Digitize.AI's Lia technology uses real-time analytics and machine learning to automatically check for new cases and securely submit them directly to payers.
By Mike Miliard 03:44 pm June 28, 2019
The CEO says cash raised by the stock offering will help broaden the analytics and data capabilities it can offer its payer and provider customers – and drive innovations in AI, blockchain, robotics and more.
By Mike Miliard 12:34 pm June 24, 2019
The tool can help health systems optimize submissions and better predict potential issues with claims, the company says, giving recommendations to help mitigate denials before they're submitted.
By Nathan Eddy 08:57 am March 29, 2019
IaaS and SaaS offerings are enabling payers to run analytics against claims and other data in new ways that enable them to operate more efficiently.

"For the first time, we are proposing that all health plans doing business in Medicare, Medicaid, and through the federal exchanges share health claims data and other important information electronically with their patients," said CMS Administrator Seema Verma at HIMSS19.

By Mike Miliard 12:59 pm March 27, 2019
The insurance group says it's supportive of more data sharing, but says CMS' timeline for API-enabled access is too aggressive.
Telemedicine consultation.
By Jeff Lagasse 11:14 am March 19, 2019
Until November, reimbursement for remote patient monitoring services was a gray area for providers, but the picture is becoming clear.
cloud
By Nathan Eddy 09:16 am March 19, 2019
IDC and Ponemon experts highlight the advantages of storing insurance claims information in a could and offer advice about security and data control.

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