Regional non-profits and health plans wholly owned by hospital systems may be facing challenges in the market today, especially considering COVID-19. Analytics suggest patient volumes are trending downward, causing impacts to incoming revenue streams and creating constraints for these critical resources. Therefore, it is not surprising to find some of these health plans are running […]
Burlington, MA, November 2, 2020 – HealthEdge Software, Inc.® (“HealthEdge”), today announced that leading healthcare analytics and enterprise software expert, Anita Pramoda, has joined its Board of Directors. Ms. Pramoda is the Founder and CEO of Owned Outcomes, Inc., a health analytics software company. She also serves as the Chairperson of the Board of Directors of the […]
Transparency in Coverage Final Rule On October 29th, the Transparency in Coverage Final Rule was released and will be published in the Federal Register. We reviewed the Proposed Rule which impacts health plans, which would require health plans to provide personalized out-of-pocket cost information for all covered healthcare items and services. This information that a […]
For claims and pricing teams, managing fee schedules can be a massive headache. With Medicare undergoing major quarterly updates as well as policy adjustments and retroactive changes coming in regularly, fee schedules require constant maintenance. Add in Medicaid policies and rates, perhaps across different states, and the lift begins to grow exponentially. And when there […]
HealthEdge’s Latest Voice of the Market Survey reveals health plans focusing on lowering administrative costs Burlington, MA, October 27, 2020 – HealthEdge Software, Inc.® (“HealthEdge”), provider of the industry’s leading integrated financial, administrative and clinical platform for health insurers, HealthRules® Payor, today announced the results of the latest Voice of the Market Survey, an independently-commissioned […]
I know regulations can seem overwhelming, but if you look beyond checking the boxes to ensure compliance, there is so much opportunity. I always try to remind the health plans I work with that regulations result from constituents going to their legislator with a problem that needs to be fixed, eventually resulting in a mandate. […]