Distributed Healthcare Intelligence
Get in-network, get paid correctly, and know what changed.
Plain-language analysis of payer contracting, credentialing, managed care and reimbursement, linked to the primary sources.
Latest analysis
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Telehealth Landscape Overview 50 States + DC
No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from…
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Cognitive Assessment & Care Plan Services
If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a…
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Medicaid MCO Quality Ratings
https://www.kff.org/medicaid/state-indicator/medicaid-mco-quality-ratings/view/print/?currentTimeframe=0&print=true&sortModel=%7B%22colId%22:%22State%22,%22sort%22:%22asc%22%7D NOTES Notes Data reflect NCQA’s 2019 ratings of Medicaid managed care plans. The plans included in the NCQA data do not always match the MCOs in other…
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Florida Law Reminder for Early Prescription Refills (Managed Care Plans)
Tallahassee, Fla. – Following Governor DeSantis’ Executive Orders 21-150 and 21-151 in response to Tropical Storm Elsa, the Florida Office of Insurance Regulation (OIR) issued the following notice to all health insurers, managed…
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Resources to Pay for Prescription Drugs
Insurance companies regularly update their formularies to classify drugs under certain payment categories. It’s best to ask your doctor to help you find out what payment category your…
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FLORIDA: Policing Reforms to Reduce Violence Against Minorities Effective Immediately
House Bill 7051, the package of policing reforms negotiated this spring by members of Florida’s Legislative Black Caucus and Republican leaders, was signed into law late Tuesday by…
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Alternative Payment Models · Innovations · Providers · Reimbursement · Resource · Value Based Care · Value Based OperationsCMS Bundled Payments for Care Improvement (BPCI) Initiative: A Discussion on Bundled Payments
There is a large disconnect between what occurs after a patient is discharged from a hospital (acute) and what occurs thereafter. The quality of care is entirely unmanaged,…
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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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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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Pandemic Creates Extra Cyber Risk For Health Care Providers
Unfortunately, it is in these times of dogged, urgent focus on patient care that health care organizations may be most vulnerable to another invisible danger: cybercrimes targeting the very hospitals…
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ALTERNATIVE CARE SETTINGS: TELEMEDICINE AND RETAIL CLINICS
Many firms provide coverage for health services delivered outside typical provider settings. Telemedicine is the delivery of health care services through telecommunications to a patient from a provider…
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2021 Performance Period Eligible Professional / Eligible Clinician eCQMs
The document outlines 47 electronic clinical quality measures (eCQMs) for Eligible Professionals/Clinicians for the 2021 performance period. It categorizes various measures based on quality domains, including effective clinical…
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Carenodes, a Healthcare Infrastructure Developer, Wins Two Best in Class Awards From Health Net and ComPsych for its Pandemic Response
Jan 25, 2021 (AB Digital via COMTEX) — Los Angeles, CA – ComPsych® revealed the 2020 winners for its 16th-annual Health at Work Awards. This award honors organizations…
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PIL Letter to the UC Regents
PIL Letter to the UC Regents To: Office of the Secretary and Chief of Staff to the Regents 1111 Franklin St.,12th floor Oakland, CA 94607 Dear I am writing on behalf of…
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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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Provider – Contracting: KPIs
KPI / Metric Formula or Definition Target Business Purpose Gross Revenue Gross Revenue or “Top Line Revenue” is synonymous with gross charges associated with the provision of services…
Browse by topic
Payer contracting
Fee schedules, assignment clauses, termination terms and negotiation.
Reimbursement & billing
Underpayments, denials, appeals and the contract terms behind them.
Managed care
HMOs, MCOs, capitation, Medicaid and Medicare Advantage.
Value-based care
Alternative payment models, ACOs and VBCA Podcast recaps.