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Category: Government Markets

  • Hidden Operational Healthcare Costs

    Friction: The Hidden Operational Drag Driving Up Healthcare Costs

    Friction is the hidden drag slowing healthcare down — driving waste, raising costs, and creating unnecessary burden for patients, providers, and payers. When stakeholders operate from different data and disconnected processes, affordability becomes impossible. Peter Henry, Vice President of Government Affairs & Policy shares how reducing operational friction and building shared transparency can transform efficiency and protect patients from avoidable complexity.

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  • Man in a dark suit touching a glowing digital network sphere representing data connectivity

    The No Surprises Act IDR Process: Simplifying the Complex

    The No Surprises Act and the IDR process present unique challenges for payors and providers – from an inefficient portal to a shortage of IDR entities and constantly changing rules. In this blog post, we discuss the top 8 challenges we’ve encountered and what you can do to address them.

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  • Data Mining

    Using a Data Mining Service on Claims Data Can Reveal Significant Overpayments

    Data Mining, a post-payment payment integrity service, detects errant medical claims in sets of data. Errant claims typically include duplicate payments and claims with billings issues that lead to overpayments. MultiPlan identifies errant claims by scouring the data. We use artificial intelligence, including machine learning and algorithms, to identify incorrectly paid claims and anomalies in the data. We also have subject matter experts on our data mining team review all findings to confirm the findings of the technology. All findings are presented to our clients for approvals.

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  • Branded dark navy graphic with the PHCS logo and the question What is the PHCS Network

    PHCS Network Brings Stability and Flexibility to an Evolving Market

    Claritev's PHCS Network is the largest independent, nationwide primary preferred provider organization (PPO). It is the preferred choice for health plans wanting a provider network with flexibility to meet their unique needs. Plans get administrative ease without sacrificing provider access, savings, and quality for health plan members.

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  • PHCS and NCQA logos with stethoscope

    MultiPlan’s PHCS Network Receives Eleventh Consecutive NCQA Accreditation in Credentialing

    In 2022, MultiPlan’s PHCS Network, the largest primary PPO in the nation, received its 11th consecutive Accreditation in Credentialing from the National Committee for Quality Assurance (NCQA), a private nonprofit organization dedicated to improving health care quality. The PHCS Network is the only national independently contracted primary PPO with NCQA accreditation, demonstrating its unique commitment to the accurate and efficient credentialing of health care professionals.

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  • Man sitting on stairs while rubbing his hurt back

    What Is Subrogation?

    Subrogation? What is it and what does it have to do with healthcare insurance? Subrogation, in layman’s terms, means a health plan can be reimbursed by the party whose insured was deemed responsible for an accident or injury.

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