Claims Processing

These key performance indicators reveal a lot about whether turning to a third party will prove to be a worthwhile investment and yield an adequate return.

A deposition reveals former medical director never looked at patient medical records, but Aetna says correct guidelines were followed.

While MVA and workers' compensation claims are only a small percentage of a healthcare organization's total claims, they can amount to millions of dollars in annual revenue for many hospitals and secure higher reimbursement rates than commercial insurance.

Its new Insurance Checker feature seeks to ease a common pain-point: deciphering, understanding and verifying health insurance.

Total costs of Kymriah and 21 similar drugs in development - CAR T-cell therapies - will reach $1 million or more per patient, according to leading cancer experts.

St. Francis Hospital used web-bots to replace manual queries to payers, yielding instant transactions that immediately find information providers need.

Mackinac enables easier collaboration, expedited document sharing between providers and payers, Hyland says.

Engaging with different stakeholders and coaching care teams has helped the health system realize a 40 percent improvement in 30-day readmissions.

Here's what you need to know about taking claims management to a higher level.

Recovery effort came with a price tag of roughly $118 per claim, or as much as $8.6 billion in appeals-related administrative costs, Change Healthcare said.