HealthHelp’s Post

Navigating prior authorization is key to reducing healthcare costs and ensuring evidence-based care. While gold carding offers some efficiency, HealthHelp’s Quality Performance Program provides an innovative, data-driven alternative. Looking to streamline your authorization process? Let’s connect!

Employers are leveraging claims databases to identify high-value healthcare providers and drive care to them, improving outcomes. A national APCD could provide a comprehensive dataset to support transparency and lower healthcare costs. Learn more: https://hubs.ly/Q01X1nB80

Unlocking payer data through the #priorauthorization rule fosters transparency, collaboration, and efficiency, reshaping healthcare for better outcomes. #HealthcareTransparency #DataLiberation #Healthcare #DistilINFO. https://lnkd.in/da2iBBNy

Are payers complying with price transparency rules?🤔 In the world of #healthcare, #price #transparency rules have been put in place to empower patients and help them make informed decisions about their healthcare expenses. But are payers truly complying with these rules? Let's dive in. ♤While progress has been made in implementing price transparency measures, it is clear that there is still work to be done. Studies have shown that many payers are not fully complying with these rules, making it challenging for patients to access the information they need to make cost-effective choices. ♤To ensure #compliance, it is crucial for payers to prioritize transparency and make pricing information readily available to patients. This includes providing clear cost estimates for procedures, medications, and other healthcare services, as well as establishing user-friendly platforms for accessing this information. ♤By holding #payers accountable and advocating for increased transparency, we can create a healthcare system that empowers patients to make informed decisions, promotes fair pricing, and ultimately improves the overall quality of care. Let's continue to push for greater compliance with price transparency rules and work towards a more transparent and patient-centric healthcare landscape. #HealthcareTransparency #InformedDecisions Credits: Jakob Emerson & Becker's Healthcare https://lnkd.in/erYw6m2j

Health plan executives are you ready of the new CMS interoperability requirements for prior authorizations? See post below for high level overview.

CMS Interoperability Final Rule To Enhance Prior Authorizations CMS has made a significant change to its Interoperability Prior Authorization rule by requiring the use of APIs to automate processes for government payer types. This change may lead to better care coordination, increased efficiency, and improved patient outcomes. The CMS-0057-F rule has the potential to decrease information delays for prior authorizations, care transitions, payer-to-payer information sharing, and patients' access to real-time information. #CMSInteroperability #PriorAuthorization #HealthcareTechnology #APIs Read more about this Final Rule and its potential impact on the healthcare industry in this article: https://lnkd.in/gwF4weCs. Author Jeff Lewis, CEO and Founder of (nextgenec.com), Executive Coach and Consultant with over 16 years of leadership experience, is committed to changing the way healthcare is paid for and delivered so that it is safer, kind, equitable, efficient, and affordable for all.

Collaboration between payers and providers isn't just a matter of convenience—it's a necessity born from the shared goal of patient well-being, highlighted by the need to navigate through the intricate landscape of healthcare transparency. Furthering transparency demands innovative solutions that streamline processes to promise not only cost reductions and efficiency gains but also a fundamental shift towards a more cohesive and patient-centric healthcare ecosystem. #Healthcare #PayerProviderRelationship #PatientExperience

It’s critical to recognize the interconnectedness of the burden consumers face in managing their healthcare and managing the business of their healthcare. Improving the patient journey requires us to take a hard look at the current challenges and opportunities that exist in the healthcare system today from both the clinical and administrative perspectives.

Interoperability Rule to Accelerate Payment Health systems and physicians, listen up! The new CMS Interoperability Final Rule is something you don't want to miss. Why? Because it means faster payment processing and less pain points. The rule requires government payers to invest in APIs, ensuring more rapid health information exchange for prior authorizations. And that's not all - standard requests will now have a turnaround time of only 7 days, a 50% decrease from the previous 14-day timeline. But here's the catch: health systems and physician groups will need to make investments to take advantage of the benefits from this new rule. It's a small price to pay for faster payment processing and less headaches. Check out the link for more information on the CMS Interoperability Final Rule. #healthcare #CMS #interoperability American Hospital Association American Medical Association

Payers always need to evaluate the quality and effectiveness of healthcare services. The most critical data is patient outcomes. Read how this data is helping health plans make informed decisions about coverage, pricing, and provider partnerships. https://lnkd.in/gXxVhqei #payer #provider #outcomesdata