claims

UnitedHealth subsidiaries settle mental health parity allegations for $15.6M

UnitedHealthcare and United Behavioral Health agreed to the settlement to resolve allegations that they illegally denied coverage for mental health and substance use disorder treatments. The allegations are related to business practices they no longer use, parent company UnitedHealth Group said.

Self-service patient registration isn’t just for the pandemic

Consumer-led care hit its stride during the pandemic. COVID-19 unlocked healthcare’s digital front door, giving patients more control over how and when they schedule and manage appointments. Unfortunately, while digital patient access has made navigating the healthcare system more convenient and flexible in many ways, consumers are discovering that one of the more frustrating aspects …

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BCBS of Kansas City sues Covid-19 testing provider over alleged price gouging

GS Labs, a Covid-19 testing provider, has submitted over $9.2 million in claims to the insurer as a result of its grossly inflated prices, the lawsuit states. The testing company rejected the claims, saying its “prices accurately reflect the level of service” it provides.

UnitedHealthcare nixes some out-of-network coverage for non-emergencies

Per a policy update that went in to effect July 1, the health insurance giant is not covering non-emergency services that members receive at out-of-network facilities that are outside of their service area. This update mainly affects residential treatment facilities, inpatient rehabilitation and other non-hospital-based services.

Emergency physicians oppose new UnitedHealth policy enabling retroactive ED claims denial

UnitedHealthcare is instituting a new policy beginning July 1 that changes how the payer assesses emergency department claims, allowing it to retroactively deny ones it deems “non-emergent” or not an emergency. The American College of Emergency Physicians has made its opposition clear, stating the policy may violate federal law.

Navigating the complexities of health coverage and reimbursement beyond the pandemic

Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has compounded many of the challenges of the last 12 months. …

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Q&A: Optimize reimbursements by submitting cleaner claims

Many thought the end of COVID-19 was in sight with the availability of a vaccine, and while that is somewhat true, an entirely new set of issues has arrived: how to properly administer and manage the vaccine. Now that a COVID-19 vaccine is approved and underway, providers need to execute a medical billing and coding …

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Aetna accuses Mednax of destroying evidence in overbilling suit: 5 things to know

In a lawsuit filed three years ago, Aetna alleged that Mednax had overbilled for medical procedures and services. Now, the insurer is accusing the medical group of destroying evidence pertaining to the suit and has asked a federal court to sanction Mednax.

Success at a glance: finding unidentified coverage

It is estimated that 30-50% of denied claims occur on the front end during the patient access process, namely during registration, authorization and eligibility. Unfortunately, manual patient intake processes contribute to these denials, and ultimately, the bottom line, staff productivity and the patient experience take the hit. Banner Health chose to automate its patient access …

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What is Revenue Cycle Management?

There is no question that providers’ bottom line has been hit hard this year, and a new surge in COVID-19 is bound to threaten hospital finances once again. As healthcare providers look to supercharge their payment velocity during these uncertain times, it’s worth taking a step back to examine the revenue cycle management process as …

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Five ways to reduce claim denials

Claims denials put a big dent into the budgets of healthcare providers – something many organizations can’t afford today given the current pandemic. In an environment where everyone must do more with less, reducing claim denials could release vital revenue and staff time to create breathing space for quality improvement. The good news? About 90% …

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UnitedHealth must reprocess thousands of illegally denied mental health claims, judge orders

In a trial last year, a federal judge found that a UnitedHealth subsidiary had illegally denied mental health and substance use disorder claims. The same judge has now ordered the payer to reprocess all the claims and reform its guidelines.

4 Tips for Launching Telehealth Services

With COVID-19 leading to postponed and cancelled medical appointments, more consumers are turning to “contactless care”. Recent figures suggest telehealth adoption has shot up from just 11% in 2019 to 46% over the course of the pandemic, and some providers are seeing up to 175 times the number of telehealth patients than pre-COVID. As they …

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