In the wake of the global COVID-19 pandemic, the intricacies of healthcare have taken on a new dimension, revealing gaps…
Healthcare Compliances and regulations
Information Blocking Rule: The changes for 2023
As we can see from the above infographic providers are facing the wrath of information-blocking claims. 6th October 2022, HSS…
Telehealth Reimbursement Policy Reforms for 2023
What Does CMS Have to Say: 2023 Medicare Physician Fee Schedule In 2019, a terrible pandemic swept across the world.…
Patient Protection and Affordable Care Act – Benefits and Payment Parameters for 2023
The Patient Protection and Affordable Care Act, also known as Obamacare, signed into law on March 23, 2010 has had…
Utilize Data Analytics to Reduce Member Dropout
Member management is crucial to healthcare payer organizations. Member engagement KPIs are what decide a payer’s Net Promoter Score. This…
How Do Analytics Help Reduce Payer’s Burden?
Before we step into how data analytics can transform a payer’s organization for the better, one must address the chains…
The Various Facets of FHIR
FHIR has taken the healthcare industry by storm. Health plans are rushing to incorporate FHIR into their systems to not…
The Genesis of FHIR
The need for interoperability was first highlighted back in the 1980s when payer organizations had to expand to working with data from…
Provider Network Management Challenges and Solutions
Managing a provider network can be a time-consuming and repetitive task because government regulations are constantly changing. Furthermore, each organization…
Here’s What You Need to Know About Provider Network Management
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…
Electronic Prior Authorization For Medicare Part D – The Essentials
The new CMS mandate for Electronic Prior Authorization (ePA) requests focuses on the NCPDP SCRIPT version 2017071 standard for four…
Expanding on Previous Rules to Improve Interoperability and Reduce Burden
Back in May 1, 2020, The Centers for Medicare & Medicaid Services (CMS) introduced the Interoperability and Patient Access Final…