Claims Processing
Spending on psychiatric drugs grew 5.6 percent from 2004 to 2005, down from the 27.3 percent growth from 1999 to 2000, according to a study in the February issue of Health Affairs.
The SCIOinspire Corp., a provider of analytics-driven business process solutions for health plans and hospitals, has acquired National Audit, a healthcare claims audit and payment integrity services provider to large commercial and Medicare and Medicaid payers and pharmacy benefit managers.
Blue Shield of California will comply with a request by California Insurance Commissioner Dave Jones to delay planned rate hikes for nearly 200,000 individual policy holders for 60 days to allow the commissioner's office time to examine them.
A new study by the American Medical Association shows that many health insurance markets across the country lack significant competition and are instead dominated by one or two insurance companies.
A report from the California Nurses Association/National Nurses United charges that health insurers in California denied 26 percent of all claims submitted through the first nine months of 2010.
Patients hospitalized for major acute medical conditions - including heart attack, stroke and pneumonia - are less likely to die in high-spending hospitals, according to a new study in the Annals of Internal Medicine.
On February 2, 2011, the Centers for Medicare & Medicaid Services is publishing a final rule implementing provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under the Medicare, Medicaid, and Children's Health Insurance Program (CHIP).
Harvard Pilgrim Health Care and Tufts Health Plan have signed a memorandum of understanding to explore a merger of the two health plans.
New reimbursement models driven by healthcare reform top the list of healthcare provider predictions for 2011 from IDC Health Insights analysts Judy Hanover and Lynn Dunbrack.
The government's healthcare fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars for the Medicare, Medicaid and Children's Health Insurance Program in 2010, the largest sum ever recovered in a single year, according to findings published in the government's Health Care Fraud and Abuse Control Program report.