Intelligent Document Processing for Payer Cost Savings
Intelligent Document Processing (IDP) is a technology that uses artificial intelligence (AI) and machine learning to automatically extract and process data from documents such as claims forms, invoices, and medical records. This eliminates the need for manual data entry and speeds up the processing of claims and other documents.
AI Practices of Healthcare Payers
AI Practices: Healthcare payers, such as insurance companies and government agencies, are increasingly turning to artificial intelligence (AI) to improve their operations and provide better services to their members.
Health System Best Practices for Improving Performance
Health System Best Practices: Profitable health systems tend to exhibit certain behaviors and policies that distinguish them from less profitable ones. Here are some of the most common.
Health Plan Headaches Need Long-term Solutions
Health plan headaches begin with several challenges while navigating the rapidly evolving healthcare landscape. These challenges are driven by a combination of factors, including rising healthcare costs, regulatory changes, technological advancements, and shifting consumer expectations.
Medicaid Growth in 2022/23 and the Impact on Underserved Populations
Medicaid growth has been driven by several factors, including changes in federal policy, public pressure, and a greater understanding of the benefits of Medicaid for underserved populations.
Payer Best Practices for Success
Payer Best Practices for Success: The healthcare industry is one of the most critical and rapidly evolving industries in the world. Healthcare payers, such as insurance companies, play an essential role in this industry by providing financial protection to individuals and families in the event of illness or injury.
NCQA Health Plan Accreditation Updates for 2023
NCQA Health Plan Accreditation program provides a framework for assessing the quality of health plans and ensuring that they meet certain standards.
NCQA Health Plan Accreditation: 5 Reasons for Third-Party Review
NCQA Health Plan Accreditation is a rigorous evaluation process that assesses the quality of health plans and their ability to meet the needs of their members. As part of the accreditation process, NCQA requires health plans to undergo third-party review.
Understand Claim Denials Affecting Reimbursement in Healthcare
To understand claim denials affecting reimbursement requires data. In healthcare, claim denials occur when an insurer or payer refuses to reimburse a healthcare provider for a particular medical service or treatment. Claim denials can occur for a variety of reasons, such as inaccurate or incomplete billing information, lack of medical necessity, or failure to follow the proper billing procedures.
Clinical Peer Review’s Role in Modern Performance Management
Clinical peer review in modern performance management requires a secure, easy-to-use software system. Peer reviews are a form of performance evaluation that involve feedback from colleagues within the same profession or industry. In the healthcare industry, peer reviews are commonly used to evaluate the performance of clinical staff, including physicians, nurses, and other healthcare professionals.