Nalashaa Healthcare Blogs
Having provider networks is a necessity. This is true for health plans and providers or hospitals, and especially, for the enrolled members. Managing provider networks can be a lot of work. Identifying the providers and hospitals according to the parameters mentioned in…
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The healthcare ecosystem consists of three participants: payer, provider, and members. Payers and providers are constantly rolling out effective, value-based, good quality care for members. There are several ways to achieve this goal, and here we shall delve into one of them – provider networks. A health…
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The proposed rule is currently titled ‘Reducing provider and patient burden’. However, the proposed rules do not promise any reduction of burden for payers. Payers must make sure their systems…
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Since the past couple of years, the CMS began its journey to instill interoperability into the healthcare ecosystem and trying to bring about a culture of patient-centricity into the picture.…
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Back in May 1, 2020, The Centers for Medicare & Medicaid Services (CMS) introduced the Interoperability and Patient Access Final Rule. The rule aimed to improve healthcare quality provided by…
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It has been reiterated time and again by the CMS that member engagement is crucial to both the health plans and members. To the health plans, engaging with members contributes to their shared…
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Health Plans are in pursuit of ensuring that members get to choose the best healthcare service which results in better care quality and outcomes. To do so, they are expected to come up with innovative and effective member engagement strategies. As the term suggests, Member engagement is about…
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Member engagement is the new trend, taking the healthcare ecosystem by storm. Health Plans are now compelled to make themselves more approachable with enhanced member experience. By definition, member engagement is the interaction health…
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The healthcare revenue ecosystem is always on the move to achieve operational excellence, to offer personalized policies, proactive care programs, and preventive healthcare measures of the best quality. One way…
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The healthcare industry is going through a makeover where organizations are pushed towards patient-centricity. With the rapidly surging volume of data and care information available online, regardless of the accuracy,…
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Descriptive analytics ensures payer organizations are aware of trends in their workflows and key performance indicators (KPIs). Once a deviation within these trends is identified and addressed, stakeholders may need to be updated on the possibility of undesirable events in the future. This is…
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Payer organizations deal with data, day in and day out. It is not enough that payers fulfill their roles in the healthcare revenue ecosystem through claim management, credentialing, code entry,…
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