When you file a claim, what happens to it? The answer may be more complicated than you think.
We talked to Paul Cinelli, one of our network growth analysts, about his experience at AllWays Health Partners as a part of the Network Management Team and as a Diversity, Equity, and Inclusion staff facilitator.
UPDATE: Federal law is beginning to move towards a solution to high prescription drug prices. The U.S. Supreme Court will soon take up a case on whether states can regulate certain aspects of prescription drug reimbursement, essentially taking on pharmacy benefit managers (PBMs) and protecting pharmacies from below-cost reimbursements. In addition, the “Lower Costs, More Cures Act” was introduced in December with the aim to lower out-of-pocket spending, protect access to new medicines, and strengthen transparency, accountability, and competition. This act has considerable bipartisan support, making it likely to pass.
Today's post is from our broker blog, AllWays Insider, which is exploring pharmacy cost trends in a series of posts.
Because many of the dollar amounts reported on cost increases are so staggering, health plans and pharmacy benefit managers (PBMs) are working together to address increasing drug costs. Here are four measures aimed to control premium and out-of-pocket insurance costs and help manage prescription drug costs.
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The patient is at your front desk, smiling wide. They declare that they have had a change in insurance, and now they have DOUBLE the coverage. TWO HEALTH PLANS! Their triumphant look likely means they don’t know how much extra work this could be for the practice.
Coordination of Benefits (COB) is the process we use to figure out the primary and secondary coverage when someone has more than one policy. The many rules can be a bit confusing, so here are 9 things your practice should know about COB.
Topics: Doing business with payers
Recently we published an article about the anatomy of a CPT code. In it, we explained how these digits keep everything clear and consistent for payers and providers. But what about unlisted codes? Some payers have stopped accepting them altogether. Here's why.