What Payers Need to Know to Stay Ahead in 2025
2025 has arrived and with it brings new challenges and potential opportunities to the healthcare landscape. Payers face increasing regulatory demands, heightened expectations for interoperability, a renewed focus on payment integrity, and rising pressure to address...
Healthcare Providers Explore Payer Direct Access to EHRs, but Most Are Still Awaiting the Benefits
Healthcare providers are increasingly required to provide clinical data to payers to justify claims and get paid for the care they provide. In one recent study, nearly 15% of all claims submitted to payers for reimbursement were initially denied, including many that...
What is HEDIS? The Basics, Objectives and Significance
One of the most important tools utilized by payers across the country is the Health Effectiveness Data and Information Set (HEDIS), which is maintained by the National Committee for Quality Assurance (NCQA). HEDIS is a measurement set used to determine the efficacy of...