High Cost Of Waste

Three ways to tackle the high cost of waste

Administrative complexity continues to drive the high level of waste in healthcare. Learn how to reduce improper payments with an optimized payment integrity approach that blends advanced analytics with human expertise.

How to wake up from subrogation nightmares

How to wake up from subrogation nightmares

Ever feel like you're living through "A Nightmare on Subro Street?" Healthcare subrogation can be terrifying! Health plans are “afraid...very afraid” of what high costs and low settlements do to their bottom line. Read our spooktacular blog post on turning your subro tricks into bottom-line treats.

Coordination of benefits technology shape future

4 ways technology is shaping the future of COB

The future of healthcare coordination of benefits might not be as exciting as humans living on Mars or Oprah for president, but there are some interesting things happening in COB that are changing the way health plans approach this age-old process.

Coordination of Benefits (COB) Alignment

4 integration points to keep in mind with your COB vendor

When selecting a COB vendor, health plans are most interested in partnering with experts whose solutions deliver considerable incremental recovery opportunities with minimal disruption to their existing operations. Read our blog to see the most common integration points of alignment between supplemental COB and health plans' internal efforts.

Blog post - 4 Tips for balancing the effects of Medicare Secondary Payer (MSP) on health plan bottom line

Four tips for balancing the effects of Medicare Secondary Payer

Medicare Secondary Payer (MSP) is a multi-pronged issue for Medicare Advantage plans. If plans aren’t monitoring the effects of MSP on medical and pharmacy claims as well as premiums from CMS, they could be hurting their bottom line—to the tune of millions of dollars. MSP also introduces compliance responsibilities that plans must regard or else

Blog post - 5 Key roles that healthcare companies need for data analytics success

5 Key roles your company needs for data analytics success

What roles are necessary in your healthcare organization for successful application of your data analytics? Whatever the size, culture and maturity level of your company, I believe there are five key functions your organization needs to develop models that can help drive solutions to real-world problems.

Whitepaper - Payment Integrity Trends 2017

Payment integrity emerging as a top cost reduction opportunity for health plans

As cost reduction continues to take center stage, healthcare payment integrity is in the spotlight. Increasingly, health plan executives are recognizing the power of payment integrity functions to add significant value to a health plan’s bottom line by improving the plan’s ability to recover or avoid improper claims payments and improve accuracy of premium revenue.

Trends in Healthcare Coordination of Benefits

Trends in healthcare coordination of benefits

Advances in data management, analytics, cloud-based software, and digital communications are causing some interesting trends to take shape in the healthcare COB world.

Delivering quality service to health plans without the babysitting

Maintaining a high level of customer service and solution quality is challenging in any industry.  And because our customers are in the highly-regulated market of healthcare and health insurance products, the services and outcomes we provide are under almost as much scrutiny as the plans we serve.

Subrogation recoveries for Medicare Advantage plans

This topic has been evolving for more than 10 years as litigation and case law have disputed over the issue of whether the private cause of action for double damages under the Medicare Secondary Payer (“MSP”) Act provides Medicare Advantage (“MA”) Plans with the right to bring suit against primary payers.

It’s the perfect time to evaluate your payment integrity technology

For many health plans, payment integrity is able to influence the bottom line in powerful ways. For payment integrity organizations (sometimes called cost containment), the new year is the perfect time to evaluate what has been working well and what can be done better and more efficiently.

Post-conference wrap-up: 2015 NASP Conference

(Michele Stuart of JAG Investigations') presentation was alarming and fascinating as she showed us how vulnerable our social media activity makes us to criminal activity and walked us through steps we can take to protect ourselves.

Transforming payment integrity with transparency

As the healthcare industry continues to transform, it has become clear that the need for increased transparency is one of the critical drivers of change. Health plans are being asked to share more information with a broad range of stakeholders in an effort to control costs and drive improvements in efficiency.

An enterprise approach to payment integrity technology

For many health plans, payment integrity is able to influence the bottom line in powerful ways. For payment integrity organizations (sometimes called cost containment), the new year is the perfect time to evaluate what has been working well and what can be done better and more efficiently. And often payment integrity technology is one of

Eligibility data management: Fixing payment integrity at the source

With all of the demands on your team, your time, and your resources, eligibility data management may not be your first priority. In our experience with over 15 health plans, eligibility data issues are the root cause of between 20% and 30% of payment integrity costs.

The right eligibility data management solution

Addressing eligibility data management can seem like an overwhelming or impossible task among all of your other competing priorities. However, fixing these data errors can eliminate downstream impacts to your payment integrity programs that are likely costing your plan millions of dollars.

How eligibility data management issues impact payment integrity

The eligibility impact: How and why eligibility data issues affect payment integrity

Over the last two months, we’ve examined how organizational and technology structures can keep health plans from recognizing, understanding, and resolving their payment integrity challenges. This month, we want to spend a little time examining one thing that can be at the root cause of some of those challenges: eligibility. Eligibility issues impact a multitude

Lack of information transparency and benchmarks hampers the payment integrity organization

By Bill Whittemore, vice president of Ajilitee, Discovery Health Partners’ sister division   In my last blog post,  I discussed some of the challenges healthcare payers face related to their lack of transparency into recovery performance results at a program level. In this post, I’d like to dive deeper into the problems caused by lack of

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