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white paper: thinking inside the box with a provider decision quadrant

Sophisticated data analytics can process billions of claim code line edits through the course of the day, helping payers...

infographic: what Aesop’s Fables can teach us about quality improvement

As we get closer to January, we know that you have a lot to keep track of for HEDIS® 2018. If you’re looking for some me...

technology, clinical power, and a unified health plan deliver better results, together

Those who seek to commit healthcare fraud and abuse are continually adapting. Often, they fly just under the radar, with...

trick or treat: solving the spooky RAPS/EDS transition challenge

Visiting a corn maze on Halloween can be fun, but trying to navigate the transition from RAPS to EDS has been more like ...

HEDIS® 2018: tech specs on deck

The National Committee for Quality Assurance (NCQA) has released its HEDIS® 2018 Technical Specifications Update, closel...

busted: top fraud and abuse busts of summer

From California to New York, fraud and abuse took no vacation over late spring and summer this year. The National Health...

HEDIS® lessons from the ant and the grasshopper

Remember Aesop’s Fables? They may be thousands of years old, but the moral of each tale is just as relevant today. One o...

improve medical record retrieval success by analyzing provider behavior patterns

Medical record retrieval is labor intensive, consumes time and resources, and requires great patience and persistence—bu...

infographic: analyzing 2017’s risk adjustment valuation to improve 2018’s processes

How is your health plan setting its target return on investment (ROI) per chart for your 2018 retrospective risk adjustm...

jumping the hurdles to value-based care

The transition from fee-for-service to value-based healthcare, where payers compensate providers based on the patient’s ...

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