Tag: 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…

What is the Justice-Involved Initiative? The Justice-Involved Initiative is a pioneering program under California’s Medicaid reforms, specifically designed to extend Medicaid coverage to incarcerated individuals. Historically, under the Medicaid Inmate…

Business Brief: Addressing Critical Needs in Population Health Partnership’s membership remained relatively stable in 2023. The member redetermination process, resulting from the winding down of the COVID-19 Public Health emergency,…

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.

The New Jersey Health Care Quality Act (HCQA), N.J.S.A. 26:2S-1 et seq. and rules establish certain rights AND responsibilities for health care providers that contract with carriers for business that…

CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the business of healthcare is to deliver the highest quality care to patients, improving clinical…

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…

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 ongoing COVID-19 pandemic, Insight…

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…