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Adopt Reference-Based Pricing Model to Contain Your Company’s Healthcare Costs

Employers can anticipate healthcare expenses once they adopt the reference-based pricing (RBP) model. With its implementation, they can determine reimbursements ahead of time, select the prices they are willing to pay for a healthcare service. RBP model saves employers from surprise healthcare expenses for their employees within their company.  RBP can result in up to…

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How to Avoid Losing Money with Medicare Repricing System

These days, employers struggle to keep up with the ever-rising healthcare costs, especially with high medical claims – how to fund them, mitigate them, and understand how they impact their plan. They face the lack of transparency issue when it comes to repricing Medicare and Medicaid costs across different health plans and networks based on…

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How Medicare Claims Editing Save You from Claims Denials?

When it comes to controlling healthcare costs, and keeping employers and providers satisfied, payers play an important role. They balance these competing objectives through processing of medicare claims as efficiently and precisely as possible.  With rising healthcare and profits getting stagnant, payers need to make sure medicare claims processing is flawless. Any errors in claims…

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Designed to Support TPAs For Today’s Complex Self-Funded Health Insurance Plans

Medicare claims repricing system is aimed at maximizing efficiencies through automation, enabling seamless transaction between providers, and members within employers’ self-funded plans, and delivering compliance.  Advantages of Self-funded Plans: Flexible options Portability from one stop-loss carrier to another Avoidance of most premium tasks Potential for financial gain TPAs gain significant cost-savings and ROI by swapping…

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Empowering Employers & Increasing Value For Self-funded Clients

Employers who choose to offer health insurance benefits to their employees have two options for paying or funding those benefits. Those two funding arrangements are self-funded benefits and partially self-funded benefits.  Self-funded Arrangement: In the self-funded benefits arrangement, the employers guided by third party administrators (TPAs) creates, defines, and establishes a benefit plan for their…

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What is Medicare Claims Repricing? Is Medicare Claims Repricing So Hard Anymore?

Medicare and Medicaid repricing system enables healthcare payers to efficiently manage healthcare provider data and automate claims pricing by leveraging its adaptive, rules-driven architecture. Medicare claims repricing can significantly lower, pre-negotiated rates which providers in the healthcare networks have already agreed. What is Medicare Claims Repricing?  Medicare claims repricing is the application of the contract…

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Referenced Based Pricing: A Solution for Employers to Cut Health Plan Costs

Reference based pricing strategy in healthcare is revolutionary. It helps both employers and employees save money by paying reduced aggregate amounts based on a percentage of what Medicare reimburses these providers. It’s truly helpful for them to bend healthcare costs downward.  Let’s Explain the Benefits of Reference Based Pricing Strategy.  With the reference based pricing…

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Value Based Healthcare

The state of US healthcare concerns us all. The rising costs are the principal concern and many of us wonder why do we spend more than other industrialized nations.  Leaving aside the assertion that the “other industrialized nations” provide the same level of care, the rising costs are definitely a problem.  Many “sophisticated” schemes were…

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3 Ways Our Software Can Streamline Your Medicare Claims Repricing

Any business that handles Medicare and Medicaid claims repricing regularly knows the pain, the labor, and the enormous time the task tends to take. Ensuring that those who are involved with the task have up-to-date and accurate information and that every person knows what needs to be done next. It is especially true for those…

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Why Healthcare Payers Can’t Get Ahead With Yesterday’s Technology?

Many healthcare insurers are still working on rigid legacy systems that hold them back from enjoying the advantages of today’s innovative systems. As a result, they keep languishing in several fronts, such as flawed compliance capability, inefficient policy management, poor customer data privacy, and lack of visibility, among others.  However, there are many insurers who…

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Top Secrets to Making Reference Based Pricing Work in the Covid-19 World

The US spends $ 3.6tn a year on health. Post Covid-19 times, this spending is breaking all previous records and people are really concerned about high out-of-pocket costs.  In times of the Covid-19 pandemic, healthcare experts anticipate healthcare costs will continue to rise. In April 2020, a health report estimated that $163.4 billion in direct…

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What are the Benefits of Using a SaaS-based Medicare Repricing Solution and Their Impacts?

Every Medicare repricing solution might be different, but almost every single one makes the same mistake by putting the company in jeopardy: it delays in complying with the CMS updates.  As a result of delayed CMS update compliance: Inaccurate payment or overpayment risks Claims re-working or readjusting Strained provider relations or increased provider inquiries Holding…

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Best Ways to Meet Payer’s Cost-Containment Goals and Protect Bottom-line During the COVID Crisis

In order to navigate the healthcare crisis and economic turmoil resulting from the coronavirus outbreak, many organizations are recalibrating their employee healthcare benefit programs. They are now more focused on finding solutions to keep their team members safe and healthy.  Yes, it is also true that many organizations across the country are being compelled to…

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How Can Employers Cut Health Plan Costs with Reference-Based Pricing?

Capping health plan expenses is gaining attention. Employers and advisers alike have been buzzing about Medicare reference-based pricing (RBP), which is a relatively new solution for controlling health plan expenses set outside traditional insurance carriers.  With Medicare reference-based pricing, employers can get in on the savings too, enabling them to control the costs of medical…

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Gaining Competitive Advantage through Medicare Prospective Payment System (PPS)

Prospective Payment System (PPS) is one of the most important policy tools in controlling ever-increasing healthcare costs. Built on a methodology that plays a crucial role in shaping providers’ incentive, PPS is gaining traction in health policy-making vis-a-vis the government’s efforts to expand health coverage to wider populations.  What is the Purpose of PPS? Prospective…

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How Leading Healthcare Insurers are Saving Millions While Ensuring Compliance

Many leading healthcare insurers used to spend too much time doing a lot of paperwork to fix billing errors, and complying with medicare regulations. That process had been too complex and labor-intensive, requiring manual collation taking weeks to finish. The outcomes were confusion, non-compliance, and errors with huge expenses.  Technology as a Saviour  Healthcare insurers…

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