Reimbursement

One regional insurer is using a new approach in provider network management, as it aims to tackle a laborious administrative process.

One of the country's largest health insurers is being accused of having misleading information on doctor and hospital network participation for EPO and PPO plans sold in the state exchange.

Health care providers have long expressed dissatisfaction with the time they spend coordinating care with health plans and getting paid. Indeed, one of the most inefficient and costly processes for both providers and payers is Prior Authorization.

For Medicare contract sponsors to remain viable, it's now necessary to perform a comprehensive Medicare program compliance review. Proposed rule changes may give CMS additional authority next year.

With spending on diagnostics alone for cardiovascular disease likely to be a major challenge for insurers amid the baby boom wave, Aetna is turning to an emerging option as part of a strategy to avoid invasive tests and treatments.

If your modus operandi is to appeal all denied claims, you may want to reconsider because some claims are not worth it.

The insurer-owned Allegheny Health Network is partnering with a national cancer center to offer new therapies and trials in western Pennsylvania, a sign of heightening regional competition and the emergence of new models for pursuing innovative treatments.

The growth of total U.S. medical costs is slowing down, but one segment is expanding fast enough to catch insurers by surprise.

The Office for Civil Rights, the HHS division responsible for enforcing HIPAA, is slated to get a new director after the official departure of Leon Rodriguez.

As the final chapter of WellCare's fraud saga closes, the company is lining up new executives and trying to grow.