Reducing Medical Billing Waste and Abuse – White Paper
Learn more about Medical Payment Integrity with our white paper on "Reducing Medical Billing Waste and Abuse."
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Case Study: Fixing vs. paying improper charges
Claritev analysis uncovered opportunities for a third-party administrator using a variety of PPO networks to: improve payment accuracy – too much was being missed in the existing editing process; gain control over clinical billing waste and abuse; and minimize provider abrasion to preserve leased network relationships.
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MultiPlan’s PHCS Network Receives Tenth Consecutive NCQA Certification/Accreditation
MultiPlan’s PHCS Network earned its tenth consecutive NCQA certification in credentialing, highlighting its consistent commitment to quality standards and rigorous provider review processes.
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Case Study: Partnering to achieve certification
A workers’ comp services provider needed help maintaining State Certified Managed Care programs by: eliminating provider coverage gaps in geographies not addressed by its proprietary network; strengthening coverage for key medical specialties.
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Karen Eaton to Lead MultiPlan’s Efforts in the Government Market
MultiPlan appointed Karen Eaton as Vice President of Sales and Account Management for its Government segment, leveraging her extensive experience to drive growth and expand solutions for federal and public healthcare programs.
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Case Study: Leveling the playing field
To improve competitiveness, a regional provider-owned health plan needed assistance with: extending network access for its highly mobile membership, containing out-of-network medical cost, and preserving its relationships and reputation with the local provider community.
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Case Study: Extending the Power of Bill Review
Claritev analysis showed a property and casualty servicer how it could strengthen its bill review and network services by: using analytics tuned to find wasteful or abusive medical billing practices not identifiable by more automated bill review programs; implementing resolution strategies appropriate for the severity of issues and nature of the provider relationships.
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Humana, MultiPlan, Optum, Quest Diagnostics and UnitedHealthcare Launch Blockchain-Driven Effort to Tackle Care Provider Data Issues
Humana, MultiPlan, Optum, Quest Diagnostics, and UnitedHealthcare launched a blockchain‑driven pilot program to improve provider data accuracy, reduce administrative costs, and streamline data sharing across the healthcare system.
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John Watkins Joins MultiPlan as Payment Integrity Vice President
MultiPlan appointed John Watkins as Vice President of Payment Integrity, bringing more than 20 years of healthcare leadership experience to help payers improve claims accuracy and reduce waste and abuse.
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MultiPlan Achieves HITRUST CSF® Certification to Manage Risk, Improve Security Posture and Meet Compliance Requirements
MultiPlan achieved HITRUST CSF® certification for its data transmission and service portal applications, reinforcing its commitment to managing risk, strengthening security controls, and meeting rigorous compliance standards for protecting sensitive healthcare data.