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nH Predict is a computer program developed by naviHealth that implements an algorithm that has allegedly been used by health insurance companies including United Healthcare and Humana [1] [2] to automatically deny coverage to patients. [3] [4] [5] It is reported to work by cross-correlating patient health records with those of other patients. [6]
UnitedHealthcare (UHC) is an insurance and managed care company with four main divisions: UnitedHealthcare Employer and Individual – provides health benefit plans and services for large national employers and individuals. UnitedHealthcare Medicare and Retirement – provides health and well-being services to individuals age 65 and older. [80]
HealthCare.gov is a health insurance exchange website operated by the United States federal government under the provisions of the Affordable Care Act (ACA), informally referred to as "Obamacare", which currently serves the residents of the U.S. states which have opted not to create their own state exchanges.
When you cut through all the complexity of the system, the bottom line remains starkly simple: The United States pays roughly twice as much as comparably wealthy countries on health care, and our ...
Medicare Advantage plans are offered by private insurers who are paid a set rate by the U.S. government to manage healthcare for older people looking for extra benefits not covered in the regular ...
UnitedHealthcare released a statement saying the company approves and pays about 90% of medical claims upon submission. They also stated that of those claims that require further review, around 0. ...
HEDIS results must be audited by an NCQA-approved auditing firm for public reporting. NCQA has an on-line reporting tool called Quality Compass that is available for a fee of several thousand dollars. It provides detailed data on all measures and is intended for employers, consultants and insurance brokers who purchase health insurance for groups.
The US Health and Human Services Department (HHS) announced Tuesday it would help doctors and hospitals find alternate claims processing platforms in order to help reboot the flow of business ...