Enrollees receiving services from out-of-network providers in Virginia for emergency or scheduled care covered by balance billing laws may go through an arbitration process if the provider and insurance carrier cannot agree on payment. The process involves timely submissions, negotiation, selection

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The Final 2022 Plan Certification Standards aim to enhance healthcare utilization, align consumer incentives, improve value proposition, and promote easy access to health information for enrollees. Modifications include coverage requirements for primary care, mental health visits, generic drugs, and

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The Missouri HealthNet Pharmacy Program and Budget Update for July 2023 provides detailed insights into the enrollees, expenditures, and services covered. It highlights the distribution of enrollees among different categories such as children, custodial parents, pregnant women, elderly, and disabled

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Ohio has approximately 161,500 full duals with significant annual costs totaling around $300 billion across Medicaid and Medicare. The care coordination opportunities for this population are profound, with MCOs needing to strategically position themselves. Preparations for serving duals under this d

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This report delves into the sources and parameters of prescription drug coverage in Medicare enrollees with chronic kidney disease (CKD) for the years 2010 to 2015. It explores the trends in Medicare Part D enrollment, out-of-pocket costs, and catastrophic coverage benefits. The data presented sheds

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Analysis of Medicaid program expenditures in August 2022 reveals interesting insights. Total enrollees in August 2022 were 1,358,275 with total expenditures amounting to $304,664,691.2. The report delves into expenditure distribution across various services, top drug classes per fiscal year, and Med

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The findings from the Cal MediConnect Rapid Cycle Polling Project conducted in 2019 focused on comparing the experiences of Cal MediConnect (CMC) enrollees by county, race, language, and disability across different characteristics such as language and need for Long-Term Services and Supports (LTSS).

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Billions of dollars are wasted annually due to healthcare Fraud, Waste, and Abuse (FWA), impacting everyone. Training and implementing effective compliance programs are crucial to detecting, correcting, and preventing FWA, protecting Medicare enrollees and the healthcare system. Non-compliance risks

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Missouri Primary Care Health Home Initiative focuses on providing comprehensive and coordinated care to individuals with chronic conditions through a patient-centered approach. It incorporates both medical and behavioral health services, promoting education, activation, and empowerment for patients.

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The figures illustrate a decline in the number of insurers available through exchanges from 2017 to 2018, resulting in decreased choices for enrollees. The data shows a decrease in counties with only one exchange insurer, as well as differences in insurer options between metro and non-metro areas. T

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This presentation provides insights into the enrollment trends of MO HealthNet Division (MHD) from 2013 to 2017 for different categories of beneficiaries. It also outlines strategic initiatives focusing on improving the quality of care, optimizing clinical outcomes, and enhancing services for Missou

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