Settlement
CMS to host BCRC and CRC NGHP town hall on April 1st
CMS has announced it will be holding a Benefits Coordination & Recovery Center and Commercial Repayment Center Non-Group Health Plan town hall on April 1, 2021, at 1:00…
LMSA update: CMS’s “future medicals” proposals now scheduled for release in March 2021 | New LMSA case decision highlights continuing claims challenges
LMSA update: OIRA has issued an updated noticing indicating CMS’s “future medical” proposals are delayed again and projected for release in March 2021.
New case highlights how LMSA issues and questions continue to complicate liability claim settlements
In Abate V. Wal-Mart Stores East, L.P. the court found CMS’s 9/30/11 memo didn’t mandate the plaintiff get a letter from her doctor certifying treatment was completed or…
CMS retains $750 low dollar threshold for 2021
CMS has announced it is retaining its current $750 low dollar threshold for 2021.
CMS NGHP Beneficiary Recovery Process webinar December 9th
CMS has released a notice announcing that it will be holding a Non-Group Health Plan (NGHP) Beneficiary Recovery Process webinar on December 9, 2020, at 1:00 p.m. ET.
Maximizing recovers boost customer satisfaction better subrogation
An effective subrogation operation is built on data and analysis. Carriers who embrace innovative subrogation will reap the rewards of a loyal and satisfied customer…
Automation requires emotional intelligence to deal with large loss claims handling
Large loss claims can be streamlined by AI and automation, but needs the emotional intelligence brought to claims resolution by the handler and the insurer.
CMS releases new NGHP Section 111 User Guide (Version 6.0) and updated accepted/excluded ICD code listings
On 10/5/20, CMS released an updated Section 111 NGHP User Guide, Version 6.0. They also released updated versions of accepted and excluded ICD-9 and ICD-10 codes for…
The future of claims: Delivering at the moment of truth
The future of claims is about elevating the customer experience, and insurers that aggressively pursue digital enablement today will be primed to excel tomorrow.
From real-time fraud detection to remote claim assessments – how lockdown has changed priorities for insurers and policyholders alike
Digital technology has become critical to provide core claims services during lockdown. Verisk is at the forefront in this field with a full range of claims solutions.
U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim
The DOJ’s Attorney’s Office for the Middle District of Pennsylvania has settled a Medicare conditional payment claim with the plaintiff law firm.
Simplify the lender-insurer information exchange
The manual process needs automation, which can benefit both lenders and carriers. Fortunately, there are solutions available to automate the communication exchange…
Connecticut court rules Medicare Advantage Plan entitled to double damages
The U.S. District Court for Connecticut in Aetna v. Guerrera, 2020 ruled, in part, the alleged self-insured supermarket was a primary plan and liable for “double damages”…
Seven steps to closed: Maximizing claims settlement projects
There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.
Eleventh Circuit rules that Florida Medicaid may seek recovery of its past payments from those portions of the settlement agreement representing past and future medical care
In a new Florida Medicaid decision, the U.S. Circuit Court of Appeals for the Eleventh Circuit, in Gallardo v. Dudek, 2020 ruled Florida Medicaid may seek recovery of…