Health Insurance Providers’ Actions Concerning Mental Health

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. The No Surprises Act, which is included within the Consolidated Appropriations Act of 2021 (the CAA), provides the following:

Carenodes Behavioral Health Case Management

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…

1-Minute Pro Tip: How to Handle Claim Denials from Private Insurance Companies

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 denial may have been caused by a clerical error such as an incorrect CPT code, a missing signature, or another simple oversight.

Sample Letter: Enlisting Patients Assistance for Claims Payment

Enlisting patient assistance in health insurance claims payment issues.

Updates to UnitedHealthcare Cost-Share Waivers

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 Market health plans for certain services. Here’s a high-level

Medical Loss Ratio

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…

Healthcare Flow of Funds explained: Healthcare Entrepreneur Bootcamp

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

Documentation and Billing of Mental Health Services: Incident – to Billing

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…

Funded by Health Net to Expand Telehealthcare

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…

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