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Healthcare Claims

Polygon to Partner with MSP on Healthcare Blockchain Initiative

by Jasmine Pennic 05/20/2022 Leave a Comment

Polygon to Partner with MSP on Healthcare Blockchain Initiative

What You Should Know: - Today, Polygon Networks, a leading blockchain and scaling solution, announced a partnership with Tokenology and MSP Recovery to deliver LifeChain - a new healthcare claims platform. - LifeChain will leverage blockchain technology to solve healthcare's biggest problems, including fraud, inefficiency in payments and antiquated processes. Tokenize Healthcare Claims On-Chain LifeChain will be developed by MSP Recovery and Tokenology as a fully tokenized Medicare,
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Olive Secures $400M At A $4B Valuation to Support New Instant Claim Payment Solution

by Fred Pennic 07/01/2021 Leave a Comment

Olive Secures $400M At A $4B Valuation to Support New Instant Claim Payment Solution

What You Should Know: - Today, healthcare automation company Olive, today announced a $400M in funding round led by Vista Equity Partners with additional investment from the Base10 Partners Advancement Initiative. Olive, a provider of AI powered workforce purpose-built for healthcare, has now secured $832 million in financing since March 2020, and $902 million since the company’s inception in 2012 bringing the company’s total valuation to $4 billion.   - The company plans to use
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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

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 ones.  What has been less recognized is the work and sacrifice
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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

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 and looking at key factors—including increases in hospital website traffic,
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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

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 for the remainder of 2020.  The reality is that an increase in
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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

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 data is used for payment reimbursement and reconciliation between the health plan and the
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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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