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In 2013, a report from Ohio Hospital Association states that CareSource is the No. 2 health insurer in the state by premium revenue. [29] CareSource celebrated 25 years as one of the nation's largest Managed Medicaid Plans and the largest in Ohio in 2014. The company then served more than 1 million consumers in Ohio and Kentucky. [30]
A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [ 2 ] Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [ 4 ]
In response, states like Ohio, West Virginia, and Louisiana have taken action to regulate PBMs within their Medicaid programs. For instance, they have created new contracts that require all discounts and rebates to be reported to the states. In return, Medicaid pays PBMs a flat administrative fee. [19]
(The Center Square) – Ohio plans to take another shot at requiring work for Medicaid expansion benefits. The state included language in the state budget, signed in July 2023, saying it would ...
Aug. 3—A recent Dayton Daily News investigation revealed that the state of Ohio has collected more than $366 million through the estate recovery program since 2017, including about $87.5 million ...
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
Your billing statement provides a detailed breakdown of the subscription fee, including benefits, required government taxes, and any additional fees. • Communication surcharges - We answer to a higher calling - the phone company.
According to the Centers for Medicare & Medicaid Services, 55% of U.S. emergency care now goes uncompensated. [7] When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. In the first decade of EMTALA, such cost shifting amounted to a hidden tax levied by providers. [12]