HighPoint Blog

A core claims and adjudication system that was no longer delivering on its promise, was the main reason a large East Coast health plan decided to replace its technology in 2016. It needed to have a system that was easy to configure, and would help the health plan move forward with its business goals.

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There are many reasons that a health plan will decide to go through the process of selecting a new care management vendor. It could be due to a change in its line of business, the need for improved operational efficiencies, a merger, or sunsetting of the vendor’s platform, to name just a few.

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Medecision’s acquisition of AxisPoint Health brings 58 VITALS and CCMS solution clients under the Medecision umbrella. These organizations have been aware of plans to sunset CCMS and VITALS since before Medecision’s acquisition, but they now have the opportunity to make a streamlined transition to Medecision Aerial platform, in addition to the option of selecting a new vendor.

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Co-authors: Norita Wilson and Becky Jones

In our previous blog A Closer Look at Population Health/Care Management Solution Vendors , we looked at Gartner’s March 2018 “Market Guide for Healthcare Payer Care Management Workflow Applications,” and its recommendations for health plans who are evaluating care management workflow application vendors.

We will now explore how health plans should...

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Co-authors: Norita Wilson and Becky Jones

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

In our previous blog, you learned about the strengths of both NCQA and URAC accreditation. Now we’ll look at how you can prepare for accreditation.

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

Health plans will look to two prominent and nationally recognized organizations, NCQA or URAC, when they are seeking accreditation. Accreditation provides an impartial opinion on a health plan’s quality. URAC or NCQA accredit a health plan when it has been determined its practices meet national standards.

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When open enrollment 2016 closed for the Health Insurance Marketplace, U.S. consumers made nearly 13 million plan selections in which they were either first-time enrollees or they adjusted their plans. Add Medicare and commercial plans to the mix and open enrollment 2017 will mean another expansion of healthcare coverage nationally, as well as a deluge of claims to process.

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