February 2019

Supporting Delegated Provider Data Management

MD-Staff Generating CAQH ProView for Groups-compatible Rosters

February 2019

The traditional model of sharing data between delegated healthcare provider groups and health plans is complex for all parties. Plans frequently receive delegated group information in varying formats and at different times. Delegated groups must maintain unique rosters and change reports for each plan, and typically do not know when plans process their data.

Health Plans Measure Results from Accurate COB Processes

February 2019

Challenges related to coordination of benefits (COB) are a financial drain for health plans and a headache for providers. Claim payments are often made in error or delayed due to complicated manual processes, as well as a lack of clarity on which plan should be the primary payer.

Prior Authorization Getting Much Needed Attention

February 2019

Prior authorization (PA) is a common source of frustration in healthcare. According to a recent survey from the American Medical Association, 28 percent of providers reported that the PA process has affected care delivery and led to a serious adverse event. Notably, 88 percent said the burden associated with prior authorization has increased over the last five years for their practice.