Value-based reimbursement is forcing hospitals and health systems to reduce costs and to improve outcomes. Whether they are trying to manage population health or to improve clinical pathways in hospitals, healthcare organizations need a way to understand and harness the huge amounts of data that could potentially be applied to achieving these goals. Artificial intelligence (AI) systems offer an approach that can derive actionable insights from large, complex datasets at the scale required by
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Healthcare Claims
Reimbursify Launches New App for Out-of-Network Reimbursement Claims
Reimbursify, a healthcare-focused technology company providing app-centric solutions for consumers, healthcare providers & businesses has launched a new app that gives patients a quick and easy way to file out-of-network reimbursement claims with their insurance company in less than 60 seconds. Users can also monitor their current, pending, and past claims from the app. Reimbursify is currently being used by patients in 21 states as well as Puerto Rico."Visits to healthcare providers who
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3 Key Areas An Automated Prior Authorization Solution Must Address
Editor's Note: Co-written by Scott Herbst, Senior Vice President and General Manager of Provider Solutions and Ryan Miller, Senior Vice President of Strategy & Corporate Development at Availity.Prior authorizations may be as popular among providers as ants at a picnic, but they have become a common and necessary part of the reimbursement process. As a result, being able to manage prior authorizations efficiently is critical to maintaining a healthy revenue cycle and avoiding issues such as
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Change Healthcare: $262B in Healthcare Claims Initially Denied in 2016
A new analysis by Change Healthcare of $3 trillion in medical claims submitted to payers last year revealed 9% of charges, representing $262 billion, were initially denied. For the typical health system, as much as 3.3% of net patient revenue, an average of $4.9 million per hospital, was put at risk due to denials. While 63% of these claims were recoverable on average, reworking each denial costs providers roughly $118 each, or as much as $8.6 billion in appeals-related administrative
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Report: Reducing Manual Business Transactions Could Save Healthcare $9.4B
Reducing manual business transactions could save healthcare $9.4 billion in savings, according to new data released today in the fourth annual 2016 CAQH Index. The index reveals that conducting resource-intensive manual transactions are costing U.S. health plans and healthcare providers as much as $11 more per transaction and on average $6 more than when conducted electronically. CAQH Index Overview The fourth annual CAQH Index measures adoption, costs and, for the first time, provider labor
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