Providers utilize business intelligence to monitor referral patterns and collaborate with clinicians who order their services. Such analytics tools have also been deployed in the specialty to improve productivity, track patient satisfaction and bolster quality.
Tennessee-based Ballad Health said it's tried for years to resolve the issues with the insurer but now has 'no choice' but to take legal action, as denied claims are leading to longer hospital stays and higher expenses.
The two companies said their model for exchanging payer and provider data will be “easily replicable” and could be adopted across the healthcare space. The initial rollout of the system will be focused on automatically identifying Medicare Advantage patients.
Physician-founded Counsel Health said it will use the funds to hire more doctors as it expands the userbase for its AI, which allows patients to ask questions and get answers from a real doctor.
The division develops and manufactures knee and hip replacements, along with other surgical implants. J&J said it will separate DePuy within 18 to 24 months, at which point it will be the largest orthopedics company in the world.
The two said they’ve been negotiating terms for eight months. Sticking points include denied claims and coverage disputes, with both the insurer and health system pointing fingers.
The settlement reached in October 2024 has been finalized. A fund is being set up for the estimated 3 million claimants, as BCBS pledges to reform its BlueCard health plans.
The initial incident happened in April. Since that time, the notorious cybercrime cell Interlock has claimed responsibility. A data dump from the breach was put up for sale on the dark web.
The insurance giant is charging the new board committee with monitoring company policies related to prior authorizations, claims adjudication and AI. The group is scheduled to meet four times a year.
Two lots of IV solution bags from the company were found to contain particulate matter that could cause blockages in blood vessels, killing a patient. To date, no serious adverse events have been reported.
That number includes $285 million in damages. CVS Health’s PBM was found to have committed fraud when it pressured insurers to overbill Medicare Advantage plans for patient care services.
Indiana-based Inotiv confirmed the data breach in a filing with the U.S. Securities and Exchange Commission. Infamous cybercrime cell Qilin has claimed credit for the attack.
Edwards Lifesciences asked the U.S. Federal Trade Commission (FTC) this week to dismiss the complaint against the company's acquisition of JenaValve this week. A healthcare market analysis firm also said the FTC actions will likely impact the timing of an FDA clearance of the Trilogy heart valve.