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4 Quick Tips for Getting COVID-19 Claims Paid Promptly

by Lillian Phelps, Sr. Director of Product Management, Availity 01/07/2021 Leave a Comment

4 Quick Tips for Getting COVID-19 Claims Paid Promptly

Lillian Phelps, Sr. Director of Product Management, Availity As the COVID-19 pandemic has gripped the world, many providers have adopted an all-hands-on-deck approach and mentality for treating COVID-19 patients, stretching their resources to the breaking point.  We have heard about the frontline heroes who have sacrificed their own health and safety to treat patients and, in less-fortunate scenarios, comfort patients in their last moments as they were quarantined from loved
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Gleaning Insights for COVID-19: Why Claims and Clinical Data Matter

by Emad Rizk, M.D., President, CEO & Chairman of the Board, Cotiviti 12/15/2020 Leave a Comment

Navigating Healthcare’s Uncertain Future: Three Data-Driven Approaches for Payers

Emad Rizk, M.D., President, CEO & Chairman of the Board, Cotiviti Healthcare organizations continue to rely heavily on data analytics to try to improve COVID-19 outcomes and public health. Since the novel coronavirus became widespread in the U.S., healthcare data scientists have leveraged clinical and claims data to pinpoint which underlying conditions put patients at higher risk of complications from COVID-19. Health systems are mining clinical data to predict surges in COVID-19 cases
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Hospital Sustainability Demands that Revenue Integrity Move Front and Center

by Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes 11/23/2020 Leave a Comment

Hospital Sustainability Demands that Revenue Integrity Move Front and Center

Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals
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Verisk Acquires MSP Compliance Provider Franco Signor for $160M

by Fred Pennic 09/11/2020 Leave a Comment

Verisk Acquires MSP Compliance Provider Franco Signor for $160M

What You Should Know: - Verisk acquires Franco Signor, a Bradenton, FL-based full-service provider of MSP compliance software and services for $160M. - Property/casualty insurers, self-insureds, and TPAs will benefit from the most comprehensive suite of fully integrated Medicare compliance solutions and greater access to the nation’s top Medicare experts. Verisk, a data analytics provider, announced today that it has acquired Franco Signor, a Medicare Secondary Payer (MSP) service
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HealthEdge Acquires Payment Integrity Solution The Burgess Group

by Fred Pennic 07/21/2020 Leave a Comment

HealthEdge Software Acquires Payment Integrity Solution The Burgess Group

What You Should Know: - HealthEdge Software announces the acquisition of The Burgess Group, LLC (“Burgess”), an innovative payment integrity software company focused on improving healthcare payment operations for an undisclosed sum. - The strategic acquisition will boost Health Edge’s position in the payment integrity market and extends best-in-class claims processing to include software-driven payment integrity - Burgess’ product, Burgess Source®, is the first solution to natively
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Why Government-Supported Health Plans Must Make Encounter Submissions A Top Priority in 2020

by Abhinav Aggarwal, Sr. Director, Encounter Submission and Risk Adjustment Solutions at Edifecs 01/27/2020 Leave a Comment

Why Government-Supported Health Plans Must Make Encounter Submissions A Top Priority in 2020

Abhinav Aggarwal, Sr. Director, Encounter Submission and Risk Adjustment Solutions at Edifecs Encounter data such as diagnosed clinical conditions and services, or items delivered to healthcare consumers to treat these conditions is the key to success for all healthcare organizations participating within the government space. Whether doctors or hospitals are submitting data for medical services rendered under Medicare Advantage, the Affordable Care Act’s state exchanges or Medicaid, encounter
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Mastercard Unveils Suite of Healthcare Solutions to Detect Fraud & Protect Health Data

by Jasmine Pennic 10/28/2019 Leave a Comment

Mastercard Unveils Suite of Healthcare Solutions to Detect Fraud & Protect Health Data

- Mastercard unveils new suite of healthcare solutions to move beyond cards and reimagining how its technology and capabilities can benefit the healthcare ecosystem. - Mastercard Healthcare Solutions will develop and provide the tools needed to protect detect fraud, waste, and abuse, capture more revenue, and protect patient health data.Mastercard today unveiled Mastercard Healthcare Solutions, a new suite of products dedicated to helping healthcare partners detect fraud, waste, and abuse,
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Change Healthcare: Applying AI Could Identify Up to 35% of Denials Prior to Submission

by Fred Pennic 06/24/2019 Leave a Comment

Change Healthcare Claims Lifecycle AI Could Identify Up to 35% of Denials Prior to Submission

Change Healthcare AI can help providers identify problem claims and prevent denials before they happen, avoiding costly rework, delays, and improving revenue flow.Today Change Healthcare announced that it has applied its Claims Lifecycle Artificial Intelligence (AI) technology to its claims management suite with the introduction of Assurance Reimbursement Management™ Denial Propensity Scoring and Revenue Performance Advisor Denial Prevention. With performance enhanced by Claims Lifecycle AI,
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Change Healthcare Unveils Claims Lifecycle Artificial Intelligence

by Jasmine Pennic 02/12/2019 Leave a Comment

Change Healthcare Unveils Claims Lifecycle Artificial Intelligence

Change Healthcare today announced Claims Lifecycle Artificial Intelligence, a new capability being integrated into the company’s Intelligent Healthcare Network and financial solutions, to help providers and payers optimize the entire claims processing lifecycle.Claims Lifecycle AI OverviewThis Change Healthcare Claims Lifecycle AI service is trained on more than 500 million service lines making up over 205 million unique claims that touch $268 billion in charges. The service leverages the
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Waystar Acquires UPMC’s Ovation Transaction Services Business for Enhanced Claims Monitoring Capabilities

by Fred Pennic 10/03/2018 Leave a Comment

Waystar Acquires UPMC’s Ovation Transaction Services Business for Enhanced Claims Monitoring Capabilities

Waystar(formerly known as ZirMed), a provider of healthcare revenue cycle management services, today announced it will be acquiring a major part of the transaction services technology business of Ovation, a health information management and management cycle solution currently owned and operated by University of Pittsburgh Medical Center (UPMC). Financial details of the acquisition were not disclosed.Ovation Transactions uses advanced algorithms to monitor claims at many health systems and
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