Medical Claims

Latest Headlines

Latest Headlines

UnitedHealth agrees to $11.5M settlement over claims payment

UnitedHealth will pay $11.5 million as part of a settlement with state medical societies and individual doctors who sued the insurer 15 years ago over how much it pays and codes claims.

More proof that sick enrollees flock to exchanges

Health technology firm Inovalon Inc. analyzed medical claims and found people enrolled in new healthcare reform plans have higher rates of serious health conditions than other insurance customers, The Wall Street Journal reported.

Excellus: 3 key pieces of data drive Rx savings

Thanks to data analytics, Excellus BlueCross BlueShield in Rochester, New York, has been able to drive clinically optimal treatments along with cost savings.

Good reasons to audit group data

Audits of employer groups' medical and pharmacy claims should occur every one to two years, with extra "implementation" reviews done when new claims-related vendors start working, according to Employee Benefit News.

Study: Medical claims costs to jump 32% by 2017

By 2017, insurers will be spending an average of 32 percent more for their individual members' medical claims, according to a new study from the Society of Actuaries.

Aetna earnings dive 49% with $120M settlement

Aetna's fourth-quarter income plummeted 49 percent to $190.1 million, thanks to a multi-million dollar settlement and higher costs related to employer-based insurance coverage.

Anthem must stop collecting overpayments

Anthem Blue Cross Blue Shield must stop trying to collect reimbursements that it believes were overpaid to providers, California state regulators said on Monday.

Insurers process a tenth of claims inaccurately

The seven largest insurers--Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, Medicare, Regence and UnitedHealthcare--paid providers the incorrect amount or incorrectly processed 9.5 percent of medical claims.

Feds probe Humana on claims, doc loans

Humana is the subject of an investigation by the U.S. Justice Department regarding its coding of medical claims and loans to physicians in South Florida. Humana disclosed in a recent regulatory

Aetna's Q1 earnings dive 13% with higher claims costs

Aetna's first quarter revenue plunged 13 percent--its largest drop in almost three years--because of high claims and administrative costs. The third largest health insurer said Thursday that it...