Aug 4, 2023 | Algorithms, Forensic claims review, Lawsuits, Self-funding
In claims progressing, algorithms – mathematical formulas used to scrutinize particular elements of a claim form – can be good when used to ensure the accuracy and consistency of claim payments… but bad when used as a tool to deny claims. In a class action...
Aug 3, 2023 | Dental, MedBen PreceDent, Wellness
Just as establishing and maintaining a relationship with a family doctor is important to better personal wellness, so too is visiting the same dentist for regular checkups. HealthTechZone highlights the benefits of having a family dentist, including: Consistent And...
Jul 25, 2023 | Caroline Fraker, Claims data, Compliance, Consolidated Appropriations Act of 2021 (CAA), No Surprises Act (NSA), Regulatory
MedCity News reports on the latest in a series of lawsuits by large self-funded employers against national carrier administrators. These cases place a spotlight on health plan administrators that do not provide employers access to their medical claims data, in...
Jul 24, 2023 | Compliance, Department of Labor, Mental Health, News, Regulatory
On July 10, 2023, the United States Office of Management and Budget (OMB) received the Department of Labor’s newly proposed Mental Health Parity regulations. This latest installment in health plan Mental Health Parity compliance is expected to be released in the near...
Jul 21, 2023 | Diabetes, Medicare, Ozempic, Pharmacy, Prescription, Research, Trulicity, Weight loss
A Kaiser Family Foundation (KFF) analysis of the 10 top-selling prescription drugs under Medicare Part D offers an interesting snapshot of pharmacy spend. The drugs in question comprised less than 1% of all covered drugs in 2021, but made up approximately 22% of total...
