Topic
Managed Care
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From HMOs to Homerooms: What Managed Care 101 Teaches Us About California’s Youth Behavioral Health Reform
HMO, PPO, EPO, capitation, value-based care — see how these managed care basics play out in real life through California’s CYBHI Fee Schedule program and its Evaluation Hub…
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Business · Innovations · Leadership · Managed Care · MCO · Medical Loss Ratio · Medicare · Medicare Advantage · Payers · Providers · Startups · Value Based CareThe 2025 Healthcare Perfect Storm: How Rising Costs and Increased Scrutiny Impact Insurers
The blog post examines the health insurance industry’s challenges in 2025, highlighting rising healthcare costs, increased patient demand, and heightened government scrutiny. Insurers, particularly those focused on Medicare…
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New California PNA Requirements: A Shift in Healthcare Strategy
As of 2024, California healthcare plans must submit a Population Needs Assessment every three years to enhance community engagement and address diverse health needs. This shift aims to…
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Academy · Administrative Work · Business · Calculators · California · California Advancing and Innovating Medi-Cal (CalAIM) · Care Coordination · Data Tools · Finance & HR · Funding · Health Equity · KPI · Managed Care · MCO · Medicaid · Modeling · Providers · Resource · Return on Investment Calculator · ToolkitsUnlock Financial Success with CalAIM: Budget Estimator Tool for CBOs
The CalAIM Budget Estimator Tool helps CBOs navigate the financial complexities of contracting under CalAIM. It offers an Excel-based template with built-in assumptions, cost input fields, revenue customization,…
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Business · HMO · Innovations · Managed Care · Maternity · Maternity Kick Payments · MCO · Medicaid · PayersUnderstanding State-Level Variation in Medicaid Managed Care Maternity Kick Payments
Understanding State-Level Variation in Supplemental Maternity Kick Payments in Medicaid Managed Care Introduction Today, we’re exploring an intriguing study on the state-level variation in supplemental maternity kick payments…
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Care Coordination · Data Tools · Finance & HR · Funding · Managed Care · MCO · Outcomes · Providers · Reimbursement · Resource · Return on Investment Calculator · SDoH · Startups · templates · Toolkits · Value Based Care · Value Based Operations · WorkflowsIntroducing the Care MAP Tool: A Comprehensive Guide
Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource…
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Managed Care Business Models 101 – Digital Therapeutics & Health Technology
The video titled “Managed Care Business Models 101 – Digital Therapeutics & Health Technology” on the channel Carenodes provides an in-depth discussion on healthcare business models, focusing on…
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Alabama · Arkansas · Colorado · Connecticut · Data Tools · Databank · Delaware · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kentucky · Louisiana · Maine · Managed Care · Massachusetts · Mississippi · Missouri · Montana · Nebraska · Network Management · New Jersey · North Carolina · North Dakota · Oklahoma · Payers · Policies & Procedures · Regulation · Resource · Rhode Island · South Carolina · South Dakota · Tennessee · texas · Utah · Virginia · Wisconsin · Wyoming35 States with Any Willing Provider laws
As a provider, if your request to join a payer network in the following markets has been denied, you might have some recourse for appeals.
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Administrative Work · Data Tools · Databank · Managed Care · Maryland · Network Management · Policies & Procedures · Resource · ToolkitsMaryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care
Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care
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Capitation · Data Tools · Databank · Florida · Managed Care · Medicaid · Medicare Advantage · Special Needs Plans (D-SNPs)Comprehensive Medicaid Actuarial Data (FL)
Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
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Medi-Cal Managed Care Enrollment Report
This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.
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Medi-Cal Managed Care Quality Improvement Reports (CA)
Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual…
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Eligibility: Contract Language (Payer v Provider) and Sample to Use
Eligibility: Contract Language (Payer v Provider) and Sample to Use.
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Business · Connected Care · Contracting · Databank · Digital Therapeutics · Funding · HEDIS · Managed Care · Payers · Press · Reimbursement · Startups · Subcontracting · Value Based Care · virtual health · Virtual Specialty CareHealth Insurance Providers’ Actions Concerning Mental Health
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Toolkit Managed Care Resource
The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such…
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NEW RULES:Bans on balance billing and out-of-network cost-sharing
Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities.…
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Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage
Carenodes Health Enterprise Office of the Executive Dear Health Plan Representative, Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder…
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Academy · Alex Yarijanian · Fee Schedules · Leadership · Managed Care · Startups · Value Based Care
Learn to speak the Managed Care Language (101)
Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes. The aim:…
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Expert Seminar on Parity Laws and Reimbursement
Learn to speak the Managed Care Language (101)