In the first part of this series, we looked at a transformative year in healthcare and presented the ongoing shift from the Risk Adjustment Processing System to the Encounter Data Processing System. Here we present submission deadlines and what success does, and doesn’t mean, so plans are not surprised when a high acceptance rate results […]

Earlier this year, the Centers for Medicare and Medicaid Services released the results of the first year of the reinsurance and risk adjustment provisions of the Patient Protection & Affordable Care Act.

Finding the path to success in the post-Affordable Care Act world of healthcare represents a great opportunity and challenge for payer organizations. Part of that journey is changing the relationship dynamic between payers and providers.

U.S. health plans today operate in a world of rising expectations. They must work to contain rising healthcare costs, while at the same time catering more to consumers as the ultimate users of their products, rather than solely satisfying the demands of employers.