Claims Processing

The defendants allegedly used their management companies to take over rural hospitals in financial trouble and then used them to bill for testing.

The collaboration with Health Care Service Corporation, billed as Epic's first such project with a payer organization, will help health plans more easily review data for managing claims and prior authorization.

Insurers need to project the future cost of delayed elective procedures and total expenses of COVID-19 care.

During the pandemic, health plans face a reduced ability to risk-adjust their members and close gaps in care.

America's Health Insurance Plans is also promoting the continued widespread adoption and use of telemedicine.

For each person admitted into intensive care, costs, on average, could exceed $30,000, according to an AHIP study.

Nonprofit insurer is working with two financial-services partners to provide financing guarantees, advance payments and restructuring of contracts.

Prior authorization requirements have hindered freeing up hospital beds due to delays in getting inpatients to post-acute care.

Hospitals can transfer patients who are COVID-negative to post-acute care facilities without advanced prior authorization approval, AHIP's Board of Directors says.

Health plans will be responsible for data sharing and patient access in a way they're not used to. "A lot will have to go into meeting that deadline," one expert says.