Cotiviti’s Post

Today’s Medicare members are more technology-savvy than most people give them credit for—make sure your health plan is reaching as many members as possible by using digital engagement tools. Watch our on-demand webinar to learn how the Wellframe solution can help healthcare payers reach and engage with more Medicaid members in less time: https://ow.ly/Kpjj50SthMN #HealthPlanWebinar #MemberEngagement #MemberExperience #Medicare #MedicareMembers

Health plans are under significant pressure from various factors, including: 🔹 Inflation 🔹 Greater chronic care incidence 🔹 Low Medicaid reimbursement rates Read our new blog as we lay out three strategies for payers to combat rising medical loss ratios (MLR) amid these challenges. https://bit.ly/4cj2anx Michael Jablon #HealthPlans #healthcare #payments

Is your health plan ready? The Centers for Medicare & Medicaid Services finalized a rule to streamline the prior authorization process for health plans, including Medicare Advantage, Medicaid, CHIP, and Qualified Health Plans. The aim is to enhance electronic health information exchange, reduce administrative burdens, and improve access to care, with estimated savings of $15 billion over ten years. The rule establishes specific timeframes for prior authorization decisions, requires a clear reason for denials, and mandates public reporting of prior authorization metrics. Additionally, it introduces API requirements for interoperability, promoting a more efficient healthcare system. Read the details here: https://lnkd.in/diTFYNKH.

🔎 Discover how the 2024 changes in Medicare reimbursement can transform patient services for Federally Qualified Health Centers and Rural Health Clinics. Leverage RPM and RTM to improve outcomes and access: https://hubs.li/Q02rc7Rc0 #ClosingTheCareGaps #FQHCs #RHCs #RPM

We're thrilled to share our latest blog post addressing significant reforms in Prior Authorization across government-regulated health plans. The final rule targets Medicare Advantage, State Medicaid, CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plan issuers on federally facilitated exchanges. This comprehensive approach underscores our commitment to overcoming challenges in various sectors of the healthcare system. 🌟 Read the full blog post here: https://lnkd.in/eCWRZybW 🔍 Key Highlights: - Prior Authorization Reforms - Government-regulated Health Plans - Medicare Advantage, Medicaid, CHIP - Comprehensive Healthcare System Approach Let's drive positive change together! 🤝💙 #HealthcareReforms #PriorAuthorization #WelterHealthcare #HealthcarePartners #MedicareAdvantage #Medicaid #CHIP #QualityHealthcare #PositiveChange #HealthcareSystem #WHPBlogPost #MedicalServices #HealthcareLeadership #InnovationInHealthcare

From 2019 to 2023, there were 84 #Medicaid managed care RFPs released, including 68 for Medicaid health plans, 6 for Medicaid pharmacy benefit management plans, and 10 for dental benefits. A list of those RFPs can be found in our recent report, Medicaid Health Plan Request For Proposals (RFPs): An OPEN MINDS Market Intelligence Report. Read now: https://lnkd.in/edwwx8yv #MedicaidAwarenessMonth #ManagedCare

The Centers for Medicare & Medicaid Services (CMS) released the 2025 Advance Notice in January, which includes several significant updates to Medicare Advantage and Part D. Here are a few key highlights that health plans should be aware of: 1. Part D Risk Adjustment Model (RxHCC) 2. Transition to CMS-HCC V28 Risk Model 3. Health Equity Initiatives 4. IRA Healthcare organizations should prepare for these updates by ensuring their current practices align with the new risk adjustment models and performance measures. This includes enhancing data accuracy and investing in health equity initiatives. Learn how NationsBenefits®, the leader in fintech and supplemental benefits for healthcare, guides health plans to successfully navigate the ever-changing regulatory landscape to improve efficiency and minimize disruption. Our expertise in the latest proposed modifications described here and other crucial developments will ensure that you stay ahead of the curve.  Swipe to learn more about these updates.   #NationsBenefits #SupplementalBenefits #MedicareAdvantage #Healthcare #CMS #Medicare #Medicaid

Have a custom data need? Here are some examples of custom reports we can create for your specific use cases: ☑️ Cost of Care Comparison reports between competitive health plans ☑️ Comparison of private payer and Medicare / Medicaid reimbursement for specific reimbursement codes ☑️ Out-of-Network reimbursement rates by health plan Check it out here >>> https://lnkd.in/eDC6-DkJ #hexiq #pulsemedical #datascience #datasciencefordoctors #healthdata #medicalpractice #medicaldata #payerdata #insurancedata #powerofdata #datascienceasaservice #dsaas #healthcare

As the healthcare industry continues to evolve, one of the biggest shifts happening is the transition from fee-for-service to value-based care. Wouldn't you want your healthcare provider to be incentivized to improve your health outcomes? Private equity involvement in healthcare has led to limited access to care and the elimination of important health services for the sake of profitability, which raises concerns. The fee-for-service model prioritizes volume over value, potentially creating incentives for unnecessary treatment. On the other hand, value-based care focuses on patient outcomes, rewarding providers for improving health, reducing the incidences of chronic diseases, and living healthier lives in an evidenced-based way. A key player in facilitating this transition is the Centers for Medicare & Medicaid Services (CMS). While insurance companies are a separate topic, it is important to develop and test innovative payment structures and service delivery models to alleviate the burden on exhausted healthcare professionals. #medicare, #healthcare, #healthoutcomes #nursing

Achieving optimal member retention is pivotal in today’s healthcare environment. Industry benchmarks reveal compelling targets: - Medicare Advantage: 90% - Medicaid: 82% - Commercial: 86% Where does your health plan stand? Explore our latest blog, where we discuss essential strategies for healthcare payers aiming to meet or exceed these standards. Gain insights into enhancing member loyalty and ensuring competitive advantage through effective retention practices. Read Now 👉 https://lnkd.in/eCHYcQN6 #HealthAxis #ClaimsProcessing #ClaimsManagement #HealthcarePayers #StaffAugmentation #StaffingSolutions #HealthcareConsulting #Consulting #Medicaid #Medicare #MedicareAdvantage #ManagedCare #HealthcareAdministration #ProviderRelations #HealthcareManagement #HealthInsurance #TPA #ThirdPartyAdministrator #ValueBasedCare #HealthcarePayers #InsuranceClaims #MemberRetention #MemberSatisfication #OperationalExcellence