Identifying Anomalies in Claims Data Leads to More Savings for Healthcare Payors
Claritev discusses a data science initiative that identifies anomalies in the data and is helping to improve its Payment Integrity service.
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Should reference-based pricing be part of your healthcare benefits this year?
Americans are concerned about rising healthcare costs, and among the insured, almost half worry about covering their deductible. With the cost of employee benefits projected to rise, employers and employees are looking for ways to lower costs. Ryan Day, President of HST, a Claritev Company, outlines ways reference-based pricing provides value, transparency, and quality in employee benefits.
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Turning Data into Wisdom
Leveraging data science, Claritev is working to build intelligent processes into each of its solutions. Claritev's Negotiation Services was the first to benefit from a data science project with the implementation of the Negotiation Prioritization Tool.
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Merging Artificial and Human Intelligence to Pursue Payment Integrity–MultiPlan’s Ben Perryman and Evan Pollack to speak at the NHCAA Annual Training Conference
Ben Perryman and Evan Pollack of MultiPlan speak on the combined approach to using both artificial and human intelligence in payment integrity efforts at the NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference.
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MultiPlan Reports Third Quarter 2022 Results and Updates 2022 Guidance
(NYSE:MPLN) MultiPlan reports financial results for the third quarter ending September 30, 2022.
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Pre-Payment Negotiation Is Beneficial to Payors and Providers in Settling Surprise Bills
The August Final Rule clarified that arbitrators need to consider QPA along with other factors such as provider experience and severity of the patient’s illness. Claritev explores whether this clarification means payors should consider adjusting the strategy they use to process surprise bills.
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Texas Medical Association Challenges Provisions to IDR Process
On Thursday, September 22, the Texas Medical Association (TMA) filed a lawsuit challenging the August 19th Final Rule of the “Requirements Related to Surprise Billing.” The suit challenges provisions concerning the way Independent Dispute Resolution (IDR) entities must treat the Qualifying Payment Amount (QPA) compared to the additional factors described in the law: training/experience/outcomes; provider and plan market share; patient acuity; teaching status/case mix/scope of services of the facility; and prior good faith efforts to contract.
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MultiPlan Announces Participation at Upcoming Conferences
MultiPlan announces participation in the Morgan Stanley 20th Annual Global Healthcare Conference and Deutsche Bank’s 30th Annual Leverage Finance Conference in September 2022.
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NSA’s Final Rules
On August 19th, the long-awaited final rules under the No Surprises Act (NSA) were issued. Titled “Requirements Related to Surprise Billing: Final Rules,” they finalize certain requirements that group health plans and health insurance issuers offering group or individual health insurance coverage must meet when reimbursing claims determined to be surprise bills as defined by the Act.
