Episode 18 - The insider's guide to clinical appropriateness
Episode 18 - The insider's guide to clinical appropriateness
When a health plan is deciding whether to pay a claim, there’s no shortage of information to consider and reviews that m... Read more
23 Sep 2019
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18mins
Episode 17 - How to step up claim overpayment recovery results
Episode 17 - How to step up claim overpayment recovery results
Payment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery manageme... Read more
18 Jun 2019
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11mins
Episode 16 - The keys to successful claim overpayment recovery
Episode 16 - The keys to successful claim overpayment recovery
For health plans, managing payment recovery is very challenging and hard to accomplish without negatively impacting thei... Read more
7 Jun 2019
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7mins
Episode 15 - How to sharpen your inpatient auditing program with better chart selection
Episode 15 - How to sharpen your inpatient auditing program with better chart selection
Although the cost of inpatient hospital stays continues to rise, health plans are finding that their inpatient claim aud... Read more
20 May 2019
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7mins
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Episode 14 - Excellus BlueCross BlueShield's data lake journey
Episode 14 - Excellus BlueCross BlueShield's data lake journey
As they look to tame their data and turn it into actionable insights, many payers are significantly ramping up their dat... Read more
11 Apr 2019
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8mins
Episode 13 - A path to success in the changing data management landscape
Episode 13 - A path to success in the changing data management landscape
The longstanding barriers to data sharing between healthcare organizations have been breaking down over the past decade,... Read more
11 Mar 2019
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12mins
Episode 12 - Fighting healthcare fraud and abuse with NHCAA
Episode 12 - Fighting healthcare fraud and abuse with NHCAA
Healthcare organizations must constantly improve their technologies and processes to stay one step ahead of healthcare f... Read more
6 Nov 2018
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9mins
Episode 11 - How clinical validation is good for payers, providers, and patients
Episode 11 - How clinical validation is good for payers, providers, and patients
When a health plan denies a claim, the provider wants to know why it was denied. Sometimes, the answer is that a modifie... Read more
27 Sep 2018
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7mins
Episode 10 - How risk adjustment coding validation gives health plans more certainty
Episode 10 - How risk adjustment coding validation gives health plans more certainty
Compliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to the... Read more
18 Jul 2018
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13mins
Episode 09 - Navigating to better Star Ratings performance
Episode 09 - Navigating to better Star Ratings performance
You’ve submitted your final data to NCQA and CMS, marking the end of the HEDIS® 2018 marathon. Now it’s on to the next c... Read more
19 Jun 2018
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13mins
