Category: Payers

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 Advantage, must…

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 in Medicaid…

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.

Eligibility: Contract Language (Payer v Provider) and Sample to Use.

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. The No…

ETHOS AND PROGRAM DESIGN The central premise of the Carenodes Behavioral Health Case Management (BHCM) Program is to promote collaboration between all treating providers, ensuring coordination between medical care and…

Before challenging a claim, examine the reason for your denial. The reason for the payer’s denial can be found on the Explanation of Benefits or EOB. In some cases, the…

Enlisting patient assistance in health insurance claims payment issues.

To ensure members are able to access the care they need as the COVID-19 pandemic continues, UnitedHealthcare is expanding cost share waivers for our Medicare Advantage and Individual and Group…

The medical loss ratio (MLR) is the percentage of premium that health insurers spend on medical care and quality improvement activities. Prior to the Affordable Care Act (ACA), many insurance…

Agenda Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market.

BY CARENODES ACADEMY Lines of Business: Medicare, (some private payers) Certain services provided by your employee (or a fellow employee) may also be eligible for Medicare payment, but check your…

Carenodes network secures funding from Health Net Health Net has grant funded a proposal by Insight Choices, in partnership with Carenodes, to expand virtual healthcare delivery capacity and accessibility. In response to the…

As Medicare Advantage plans already know, many factors go into building a robust CMS-compliant network. One focal point should be strong provider relationships. Carenodes is committed to cultivating long-lasting relationships…

#IBELIEVE in Maternal Mental Health Access and I will fight alongside you each and every step of the way. Closing gaps in maternal mental health care seems like a no-brainer…

#IBELIEVE in Maternal Mental Health Access and I will fight alongside you each and every step of the way. Closing gaps in maternal mental health care seems like a no-brainer…