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  2. State retirees caught in middle of contract dispute between ...

    www.aol.com/state-retirees-caught-middle...

    The state’s Medicare Advantage plan allows members to see out-of-network providers for the same out-of-pocket costs as in-network providers, as long as they accept Medicare.

  3. National Correct Coding Initiative - Wikipedia

    en.wikipedia.org/wiki/National_Correct_Coding...

    The National Correct Coding Initiative (NCCI) is a Centers for Medicare & Medicaid Services (CMS) program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits:

  4. WakeMed and Humana contract dispute could last ‘well into ...

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    Almost two weeks after their contract lapsed, WakeMed and insurance giant Humana have yet to reach a deal, leaving many Medicare patients out of network. WakeMed and Humana contract dispute could ...

  5. Recovery Audit Contractor - Wikipedia

    en.wikipedia.org/wiki/Recovery_Audit_Contractor

    DHHS, through its Centers for Medicare and Medicaid Services (CMS) branch, began the program in 2005, using Recovery Audit Contractors to perform the actual work of reviewing, auditing, and identifying improper Medicare payments. At the inception of the program, it focused on Medicare payments in the states of California, New York, and Florida.

  6. Medicare Advantage - Wikipedia

    en.wikipedia.org/wiki/Medicare_Advantage

    Medicare.gov logo. Medicare Advantage (Medicare Part C, MA) is a type of health plan offered by private companies which was established by the Balanced Budget Act (BBA) in 1997. This created a private insurance option that wraps around traditional Medicare. Medicare Advantage plans may fill some coverage gaps and offer alternative coverage ...

  7. Original Medicare vs. Medicare Advantage: Which should you ...

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    The amount can range from 10 cents to the total monthly premium, according to insurance provider Humana. Part D. Medicare Advantage plans bundle Part D in the plan, so costs are typically included ...

  8. Health insurance marketplace - Wikipedia

    en.wikipedia.org/wiki/Health_insurance_marketplace

    Health exchanges first emerged in the private sector in the early 1980s, and they used computer networking to integrate claims management, eligibility verification, and inter-carrier payments. These became popular in some regions as a way for small and medium-sized businesses to pool their purchasing power into larger groups, reducing cost.

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