Topic
Payers
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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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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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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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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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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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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…
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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…
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Sample Letter: Enlisting Patients Assistance for Claims Payment
Enlisting patient assistance in health insurance claims payment issues.
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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…
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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),…
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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…
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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…
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Strong Networks Begin with Strong Healthcare Provider Relationships
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…
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#IBELIEVE in Maternal Mental Health Access: Payer Guidance & Provider Talking Points to Hold Payer Accountable
#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…
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#IBELIEVE in Maternal Mental Health Access: Payer Guidance & Provider Talking Points to Hold Payer Accountable
#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…