Healthworx, the investment arm of CareFirst, Inc., invests in RAAPID, signaling a massive market shift toward "Audit-First" ...

Healthcare is on the path toward more proactive and personalized care, and an accurate narrative about patient healthcare is the foundation for understanding what works and what does not. The ...

ECLAT Health Solutions, a leading risk adjustment and coding technology partner for Medicare Advantage, Medicaid and ACA plans, announced agentic AI tools and proprietary Confidence Scoring at RISE ...

Capturing accurate diagnostic codes through comprehensive risk adjustment programs has become increasingly important for provider-sponsored health plans to improve patient care and clinical quality.

Financial struggles at Bright Health Group and Friday Health Plans have raised concerns about how well the Affordable Care Act's (ACA's) risk adjustment program is working, especially whether it's ...

Much of the recent news around the Affordable Care Act (ACA) marketplace has focused on anticipated premium increases for 2017. This should not be a surprise as there are several known factors that ...

Humana has filed suit against the feds, saying the Biden administration's bid to claw back overpayments in Medicare Advantage (MA) is built on "shifting justifications and erroneous legal reasoning." ...

Faced with new government regulations, Medicare Advantage (MA) organizations should be utilizing technology to increase the accuracy of their coding, mitigate their risk, and ensure appropriate care ...

If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted. Both the individual and small group market risk adjustment system are based on a set of regression ...

Janus Henderson AAA CLO ETF (JAAA) gets a Buy for strong risk-adjusted returns, liquidity, and diversification; learn key risks and outlook—read now.