Kern Health Systems selects Pareo® One technology-enabled payment integrity services to shore up claims accuracy efforts. Using an integrated, provider-first approach, ClarisHealth auditors identify $3M in first 9 months for the Medicaid MCO.
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Medicaid MCO
Managed Medicaid Plan Finds Technology Partner to Grow Payment Integrity Savings
How Medicaid Managed Care Organizations Are Faring on Top 3 Issues
What can your Medicaid MCO do to prepare for this year and beyond? Medicaid managed care organizations are continually in a balancing act, facing tighter-than-average budgets, political pressures, and an evolving, uncertain healthcare landscape. The COVID-19 public...
ClarisHealth Named a Preferred Vendor by the Association for Community Affiliated Plans
ClarisHealth named a preferred vendor by the Association for Community Affiliated Plans, provides unique payment integrity and FWA technology platform for ACAP member Safety Net Health Plan digital transformation goals.
How to Evaluate Payment Integrity Solutions: The Ultimate Guide for Health Plans
Payment integrity solutions vendors make many claims. Here are the top 14 areas of evaluation to ensure a perfect fit for your health plan. Virtually every health plan is looking to address shrinking margins by moving their medical savings from a typical 1-2% today to...
5 Steps to Reducing Fraud, Waste and Abuse
Use these tech-enabled tips to comprehensively reduce FWA. States require MCOs to take proactive measures that reduce not just fraud, but also waste and abuse. But how can you ensure your efforts not only meet compliance requirements but also help secure a competitive...
Increase Agility Around These 3 Hot Button Issues to Minimize Risk in Healthcare and Politics
The 2020 presidential election is upon us, and the debate surrounding healthcare and politics is more contentious than ever. How can your health plan stay ahead of the game, no matter the outcome? Every 4 years, the cross section of healthcare and politics is put on...
The Strategy Nearly Every Health Plan Considers: Outsource vs. Insource
Slim margins, fewer resources, and consolidation have made it harder for health plans to compete. Could balancing outsource vs insource efforts accelerate their goals? With shrinking margins, fewer and fewer internal experts, and increasing consolidation, health plans...
3 Ways MCOs Can Prevent Fraud, Waste and Abuse
A robust fraud, waste and abuse program at MCOs and MAOs includes three key areas: Technology, Clinical Audit and Investigative capability. As your health plan grows its fraud, waste and abuse initiatives, there are three areas a strong prevention plan should address....
Coronavirus New Normal: What does it mean for health plan members?
25 million Americans projected to lose employer-sponsored healthcare coverage due to the COVID-19 recession. How will this disruption affect the relationship between health plans and consumers? As of the end of April 2020, about 30 million people in the U.S. are newly...
Tracking the Information Blocking Rule: It’s nearly final, but is the healthcare industry ready?
Despite public concern, the final rule is moving forward. Meanwhile, a recent survey says only 18% of healthcare execs understand the seismic implications. Both the Information Blocking Rule and the Interoperability Rule (collectively referred to as the Proposed...
Medicare for All: Should It Be Feared by Health Plans?
Worried about “Medicare for All”? You certainly aren’t alone, but health plans could view this as an opportunity. 6 Myths and facts revealed. Proposals for single-payer healthcare models — sometimes termed “Medicare for All” — top today’s healthcare news. Strong...
Lack of Documentation is a $23 Billion Overpayment Problem for Medicare
Medicare overpayment is a massive problem, and lack of documentation is a significant contributor. When we see errors adding up to billions of dollars in improper payments, we pay attention. As payment integrity technology experts and also healthcare consumers we take...
Forget the Buzzwords. Lack of progress now doesn’t mean you’ll never catch up.
3 practical steps you can take today if your health plan is feeling left behind on advanced payment integrity technology A few weeks ago, a blog reader approached me about a recent article I wrote titled “Does Your Health Plan Even A.I.?” The reader, who also happens...
Burned out and Bored? Remind Your Employees Why Payment Integrity Matters
Address the “why” behind payment integrity and you’ll find that health plan employees no longer feel stuck. Most talented employees start out in their jobs with a great deal of optimism: meeting new people, learning new things, looking forward to making a positive...
Top 10 Ways to Maximize Your Health Plan’s Recoveries
Want to maximize your health plan’s recoveries? Of course you do. Here’s how.There’s a great deal of uncertainty in healthcare today, but one thing never changes: health plans’ desire to grow their recoveries. But, stuck dealing with insufficient technology or...
Provider to Health Plan: It’s not me, it’s you.
Are you playing a costly game of “Who’s got the medical record”? 90% of your health plan’s cost containment efforts are the source of provider friction. Your health plan has one directive: control medical spend. And despite tight timelines, a shortage of skilled...
Claim Spend – Is It Too High at Your Health Plan?
Examining claim spend cost at health plans, and what kind of ROI can be expected. Controlling claim spend is nearly impossible without system visibility. By that, we simply refer to the access that some technology gives health plans and payers into payment integrity...
Addressing the $330 Billion Elephant in the Room: Administrative Complexity
Health plans can minimize wasteful spending on administra Administrative Complexity: Complex administrative processes in healthcare organizations that are increasingly seen as unnecessary and are therefore leading to wasteful spending. Nearly 10% of the $3.3 trillion...
Prepare for CMS Audits: A Guide
Here's what to expect following new CMS payment integrity initiatives, including a guide to CMS audit protocols. The pressure is on for state-administered Medicaid programs (and the MCOs that run them). New initiatives released over the summer by CMS promise increased...
How to Reduce Administrative Costs for Coordination of Benefits
Make Your Processes More Efficient for COB Cost Savings It has been estimated that the administrative costs for coordinating benefits is $800 million. Let that sink in for a second – $800 million is a lot of money to spend on a process that can be improved. Other...
A Clearer Path to Coordination of Benefits
COB Considerations for Medicaid MCOs Coordination of Benefits. Many Medicaid health plans will tell you that this area is a primary concern in their payment integrity program. It’s no wonder: statistics tell us that 4-8% of Medicaid MCO membership has other healthcare...