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March 1, 2021

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…

December 16, 2020

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.

December 7, 2020

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…

November 30, 2020

CMS retains $750 low dollar threshold for 2021

CMS has announced it is retaining its current $750 low dollar threshold for 2021.

November 10, 2020

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.

October 23, 2020

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…

October 12, 2020

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.

October 6, 2020

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…

September 10, 2020

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.

September 3, 2020

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.

August 25, 2020

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.

August 12, 2020

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…

August 7, 2020

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”…

July 8, 2020

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.

July 2, 2020

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…