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A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
The original, publicly-funded Medicare plan consists of two parts ― hospital insurance, Part A, and medical insurance, Part B. It covers hospital stays, preventative services and medical tests.
Change Healthcare Inc. (known as Emdeon before rebranding in 2015, which followed its acquisition of Change Healthcare) is a provider of revenue and payment cycle management that connects payers, providers, and patients within the U.S. healthcare system. [2]
Last week, Humana Inc (NYSE:HUM) agreed to pay $90 million to the federal government to settle a whistleblower lawsuit alleging fraudulent Medicare Part D bids. The lawsuit, filed by Phillips ...
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
A unique physician identification number (UPIN) was a six-character alpha-numeric identifier used by Medicare to identify doctors in the United States. They were discontinued in June 2007 [ 1 ] and replaced by National Provider Identifier , or NPI numbers.
Electronic visit verification (EVV) is a method used to verify home healthcare visits to ensure patients are not neglected and to cut down on fraudulently documented home visits. Beginning January 1, 2020, home care agencies that provide personal care services must have an EVV solution in place or risk having their Medicaid claims denied, under ...