Health insurance in the United States

Tufts Health Plan Launches New Online Tool to Help Members Save on Prescription Drugs

Monday, August 3, 2020 - 2:00pm

WATERTOWN, Mass., Aug. 3, 2020 /PRNewswire/ -- Tufts Health Plan announced today the launch of MyPrescription Shopper, powered by Rx Savings Solutions , a no cost, online tool designed to identify lower cost medications and provide savings opportunities to health plan members.

Key Points: 
  • WATERTOWN, Mass., Aug. 3, 2020 /PRNewswire/ -- Tufts Health Plan announced today the launch of MyPrescription Shopper, powered by Rx Savings Solutions , a no cost, online tool designed to identify lower cost medications and provide savings opportunities to health plan members.
  • "Prescription drug costs can also serve as a barrier to taking necessary medications and following a physician's treatment plan.
  • This new tool quickly identifies less expensive medications or pharmacies so our members can continue to manage their care and remain healthy."
  • Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage.

Litigation Victory: Scottsdale Medical Billing Company Obtains Full Win In Four-Year Battle Against Texas Surgical Hospital

Wednesday, July 29, 2020 - 8:28pm

ARS asserted a breach-of-contract claim against SESH after it failed to pay amounts due and owing pursuant to the terms of an "Exclusive Healthcare 'Out of Network' Claims Billing Agreement."

Key Points: 
  • ARS asserted a breach-of-contract claim against SESH after it failed to pay amounts due and owing pursuant to the terms of an "Exclusive Healthcare 'Out of Network' Claims Billing Agreement."
  • "We are thrilled at the favorable outcome of this long journey," said Tyler Grim, General Counsel for ARS.
  • "We pride ourselves on the diligent work we do for our clients, and are gratified the Court recognized that in this case."
  • Advanced Reimbursement Solutions is a subsidiary of Pantheon Global Holdings, a family-owned, multi-disciplined conglomerate with several subsidiary entities specializing in out-of-network medical billing, medical practice management and marketing, leading-edge technology solutions and full revenue-cycle management.

Kaiser Permanente Recognized for Excellent Care by U.S. News & World Report

Wednesday, July 29, 2020 - 7:55pm

According to the report:

Key Points: 
  • According to the report:
    32 Kaiser Permanente hospitals are "high performing" for one or more measures.
  • 24 Kaiser Permanente hospitals are "high performing" for congestive heart failure treatment.
  • "This recognition reflects the dedication and expertise of our physicians and care teams," said Phil Madvig , MD, interim chief medical officer at Kaiser Permanente.
  • Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health.

VALER® Prior Authorizations now in Epic App Orchard

Wednesday, July 29, 2020 - 3:07pm

HUNTINGTON BEACH, Calif., July 29, 2020 /PRNewswire/ -- VALERis now available in the Epic App Orchard to support today's manual prior authorization workflows.

Key Points: 
  • HUNTINGTON BEACH, Calif., July 29, 2020 /PRNewswire/ -- VALERis now available in the Epic App Orchard to support today's manual prior authorization workflows.
  • "With outstanding support from the Epic App Orchard team, VALER now has a clean, efficient, and cost-effective way to meet our clients' needs around prior authorization workflows," remarked Marty Staszak, CEO of Voluware and visionary architect behind VALER.
  • Key differentiators of the VALER approach to authorizations are:
    Comprehensive prior authorization submission coverage (professional, facility, technical/ancillary, medications, DME, Worker's Comp)
    As a provider dealing directly with prior authorizations, Voluware co-founder Dr. Steve Kim knew that "VALER, from day one, had to be singularly focused on solving the day-to-day workflow challenges with prior authorizations.
  • Epic and App Orchard are trademarks or registered trademarks of Epic Systems Corporation.

Verata Health and Olive Join Forces to Solve $31B Prior Authorization Issue

Wednesday, July 29, 2020 - 2:00pm

MINNEAPOLIS, July 29, 2020 (GLOBE NEWSWIRE) -- Olive and Verata Health announced today their partnership to solve the complexities of the prior authorization processone of healthcares most disruptive and costly challenges for payers, providers, and patients.

Key Points: 
  • MINNEAPOLIS, July 29, 2020 (GLOBE NEWSWIRE) -- Olive and Verata Health announced today their partnership to solve the complexities of the prior authorization processone of healthcares most disruptive and costly challenges for payers, providers, and patients.
  • Olives AI workforce is having a tremendous impact in helping health systems solve some of their most costly problems.
  • Verata Health is empowering practices, hospitals, and health systems to take control of one of the biggest and most challenging problems in healthcare -- prior authorization.
  • Supporting both simple and clinically complex prior authorizations, Verata Health helps both providers and payers increase revenue, reduce administrative burden, and accelerate patient access.

Is Kaiser Permanente Health Plan More Efficient Than Competing Blue Cross Blue Shield Health Plans and Regional Health Plans?

Tuesday, July 28, 2020 - 4:00pm

For decades, self-insured employers have asked whether Kaiser Permanente Health Plan (KPHP) is really more efficient than locally operated Blue Cross Blue Shield health plans, national health insurance companies, and community-based health plans, stated Dr. Douglas G. Cave , President/CEO of CCGroup.

Key Points: 
  • For decades, self-insured employers have asked whether Kaiser Permanente Health Plan (KPHP) is really more efficient than locally operated Blue Cross Blue Shield health plans, national health insurance companies, and community-based health plans, stated Dr. Douglas G. Cave , President/CEO of CCGroup.
  • There are several ways our health plan clients are comparing their performance to Kaiser as well as other potential health plan competitors.
  • Yuri Alexandrian , COO/CIO of CCGroup asserted, Under our subscription model, CCGroup shares overall efficiency results as well as medical condition-level efficiency results with health plans, health systems, physician groups, and employers.
  • Senior management of CCGroup has assessed the performance of physicians and hospitals for over 29 years for health plans, HMOs, physician groups, health systems, CINs, ACOs, TPAs, and employers.

CareFirst BlueCross BlueShield Brings on New Director of Public Relations

Monday, July 27, 2020 - 6:54pm

Kelly L. Ceballos, who joined the company on June 29 as the Director of Public Relations, brings more than 25 years of media relations and strategic communications experience to this role.

Key Points: 
  • Kelly L. Ceballos, who joined the company on June 29 as the Director of Public Relations, brings more than 25 years of media relations and strategic communications experience to this role.
  • As CareFirsts Director of Public Relations, Ceballos will focus on communications strategies that leverage the public and media relations for the company.
  • Kelly is a seasoned public relations professional, who adds a broad range of perspectives to the communications team already in place at CareFirst, said Mack McGee, Vice President and Chief Marketing Officer for CareFirst.
  • To learn more about CareFirst BlueCross BlueShield, visit our website at www.carefirst.com or follow us on Facebook , Twitter , LinkedIn or Instagram .

New York State PTA And Fidelis Care Launch New 'Every Child Healthy' Program For Families

Monday, July 27, 2020 - 2:00pm

"We are thrilled to partner with Fidelis Care to support our children and families across the state," said NYS PTA President Lorey A. Zaman.

Key Points: 
  • "We are thrilled to partner with Fidelis Care to support our children and families across the state," said NYS PTA President Lorey A. Zaman.
  • "Fidelis Care is proud to work side-by-side with the New York State PTA in support of the health and wellness of local children and families," said Pam Hassen, Chief Member Engagement Officer.
  • With more than two million members statewide, Fidelis Care believes that all New Yorkers should have access to affordable, quality health insurance.
  • NYS PTA is one of the oldest and largest child advocacy associations in New York State, established in 1897 to make every child's potential a reality.

L.A. Care Health Plan, Blue Shield of California Promise Health Plan to Distribute 7,000 Backpacks and School Supplies to Students

Friday, July 24, 2020 - 4:00pm

In fact, some therapists say it's important to continue the regular back-to-school traditions, like shopping for a backpack and school supplies to give children a feeling of normalcy.

Key Points: 
  • In fact, some therapists say it's important to continue the regular back-to-school traditions, like shopping for a backpack and school supplies to give children a feeling of normalcy.
  • For many, school supplies are simply too much.
  • That's why L.A. Care Health Plan and Blue Shield of California Promise Health Plan are holding seven Back-to-School Drive-Thru events through their Community Resource Centers network .
  • "Regardlessofwhatreturningto schoolmaylooklikethis year, we know students will need the necessary materials to succeed,"said Kellie Todd Griffin, Senior Director, Community and Provider Engagement, Blue Shield of California Promise Health Plan.

Blue Cross Blue Shield of Massachusetts Announces Bold New Action To Expand Members' Access to Mental Health Services

Thursday, July 23, 2020 - 5:01pm

BOSTON, July 23, 2020 /PRNewswire/ -- Blue Cross Blue Shield of Massachusetts ("Blue Cross") is announcing a set of bold new initiatives to ensure our members have timely access to high-quality, affordable mental health care.

Key Points: 
  • BOSTON, July 23, 2020 /PRNewswire/ -- Blue Cross Blue Shield of Massachusetts ("Blue Cross") is announcing a set of bold new initiatives to ensure our members have timely access to high-quality, affordable mental health care.
  • Access to mental health services is a serious issue across the country and has become even more pronounced during the COVID-19 pandemic.
  • Blue Cross recognizes the value of telehealth in increasing access to mental health care.
  • Blue Cross Blue Shield of Massachusetts ( www.bluecrossma.com ) is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston.