Whether or not health plan leaders implement a fully centralized PIO, sharing information on an enterprise payment integrity technology platform helps overcome challenges and meet strategic opportunity.
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Health Plan Leaders Speak Out on Building the Payment Integrity Organization of Tomorrow
Are You Hurting Provider NPS with Your Payment Integrity Efforts?
Look out for these 4 elements of payment integrity that may negatively impact provider NPS (net promoter scores) with your network providers. The Net Promoter Score (NPS) – an established metric traditionally managed by insights and marketing departments – can drive...
Evaluate Payer-Provider Portals on These 4 Features
Go beyond the basics with a payer-provider portal that drives engagement and decreases costs. How would you characterize the health of your relationships with network providers? If yours is like many health plans, those relationships could always improve. And...
4 Payer Responses to Primary Care Challenges
Primary care providers are the foundation of the healthcare system. With the pandemic putting its future at risk, health plans can take 4 steps to address this challenge. It’s been said that the coronavirus pandemic hasn’t created any new problems; it’s just escalated...
Health Plans Return to Payment Integrity
3 claims trends associated with the healthcare industry getting back to business, and how health plans can smoothly resume payment integrity efforts. Now that the crisis-volume of COVID-19 cases has started to ease across the country, delayed elective procedures and...
From Volume to Value: Alternative Payment Models Win During a Healthcare Crisis
As patient volumes drop due to the COVID-19 pandemic, fee-for-service payment models hurt providers. Is this finally the time for value-based care? COVID-19 is decimating provider finances. Hospitals are losing over $40 billion per month in lost revenue due to...
Modernizing communication with providers
Time to move past playing telephone with providers. Here’s a better communication strategy for health plans. By relying on fax machines and snail mail to communicate overpayments, underpayments, denials, and just about everything else, the payer-provider relationship...
Prepare to Meet the Future with Data
We revisit ONC’s Information Blocking Rule, recap public comments, and look at how health plans can meet data sharing requirements. Earlier this year, we wrote about the ONC’s proposed information blocking rule and how it serves as an opportunity for health plans....
Top 10 Ways to Maximize Your Health Plan’s Recoveries
Want to maximize your health plan’s recoveries? Of course you do. Here’s how.There’s a great deal of uncertainty in healthcare today, but one thing never changes: health plans’ desire to grow their recoveries. But, stuck dealing with insufficient technology or...
Provider to Health Plan: It’s not me, it’s you.
Are you playing a costly game of “Who’s got the medical record”? 90% of your health plan’s cost containment efforts are the source of provider friction. Your health plan has one directive: control medical spend. And despite tight timelines, a shortage of skilled...
Are Your Plan’s Healthcare Providers Happy? Tips on Boosting Your Net Promoter Score
Keeping your health plan’s providers happy will also keep your members satisfied. Here’s how technology can support your net promoter score with providers. “How likely are you to recommend this health insurer to your business associates?” Do you know how the...
Here’s Where Provider-Payer Relationships Need to Improve
Communication breakdowns with providers wreak havoc on a payer’s bottom line. Imagine, if you will, two scenarios in a relationship between a healthcare provider and a health plan. In one, a provider receives a letter from a health plan telling them a claim is...
Health Plan Member Satisfaction is the Price of Provider Abrasion
Is provider abrasion undoing all your best member satisfaction initiatives? After a recent medical appointment, I visited the front desk on the way out where the office manager/claims specialist let me know I had an outstanding balance from my preventive care visit...