photo of Maria Todd reviewing managed care contracts with a client

Price Transparency: Ready Set Go!

New and significant hospital price transparency rules are proposed for hospitals in the USA. Will you be ready in less than 4 months?...

Need Help to Appeal Denied/Rejected Claims?

Out of Network International insurers / health schemes Denied Workers’ Compensation Third-party liability (slip and fall, etc.) with Attorney Involvement Uninsured Motor Vehicle Accident Claims Lack of Medical Necessity Allegations that you lack proper authorization Coverage Exclusion or Exhaustion Pre-existing conditions on Travel Accident Insurance Denied vs Rejected A denied claim is one that an insurance...

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Sample Contract Language: Utilization Management

Utilization management is a system for reviewing the appropriate and efficient allocation of health care services under a health benefits plan according to specified guidelines, in order to recommend or determine whether, or to what extent, a health care service given or proposed to be given to a covered person should or will be...

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Why America’s Rural Hospitals Suffer under Shared Risk and Full-Risk Payer Contracts

In managed care agreements, payers regard rural and urban hospitals as “hospitals”, all uniform in character. But in reality, huge variations in the demography, economics, culture, and environmental characteristics of different rural places make them very different from their urban counterparts and distinctly different from their other rural competitors. Large rural and suburban bedroom...

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Managing Managed Care Contract Renewals

Why is the process of renewing and renegotiating #managedcare #contracts still such a challenge for providers? Are they not utilizing the tools properly? Are they not adding the contracts into their systems properly? Do the tools have some necessary features missing? Is there some other reason?...

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