I Was Not Going to Let Them Win By Anne Glorioso, CEO · Solidarity Health Network, Inc. · Cleveland, Ohio 2006, something new came along called the Retiree Drug Subsidy — RDS, for those of you playing along at home. For the uninitiated: the RDS program was a federal subsidy available to employers and plan […]
Tag: cms
Your Provider Roster Is Either Right or It’s a Problem
What ACA health plans — and the employers and brokers who work with them — need to know about provider directory rules, and why “close enough” stopped being good enough a long time ago. Let’s start with the uncomfortable truth: a lot of ACA health plans are out there right now with provider directories that […]
Credentialing Isn’t Paperwork. It’s the Backbone of Your Network.
Every health plan and every provider network has a credentialing function. Not every health plan and every network has a credentialing *system* — and the difference between those two things is where most of the downstream pain in this industry comes from. Credentialing is the gate. It determines who is permitted to bill the plan, […]
If Your TPA Never Pushes Back, They’re Not Protecting You
Compliance failures rarely announce themselves. They don’t show up with warning lights and sirens. They accumulate quietly — in a dependent verification that was skipped, a plan document that drifted from what’s actually being administered, an eligibility file that hasn’t been reconciled in months. By the time a plan sponsor discovers the problem, it’s usually […]
Keeping Patients Safe with Pharmacogenomic (PGx) Testing
How Pharmacogenomic (PGx) Testing Is Keeping Patients Safe In healthcare, one size rarely fits all — especially when it comes to prescription drugs. Every person’s body processes medications differently, which means what works for one patient could be dangerous or ineffective for another. That’s where pharmacogenomic (PGx) testing comes in — a revolutionary tool that’s […]