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Health insurance provider The Cigna Group will pay more than $172 million over claims it gave the federal government inaccurate Medicare Advantage diagnoses codes in order to inflate reimbursement.
Achieving a high clean claims rate is a key metric for measuring the efficiency of the billing cycle. Creation of the claim is where medical billing most directly overlaps with medical coding because billers take the ICD/CPT codes used by the medical coders and creates the claim. Step 6: Monitoring payor Adjudication [4]
The settlement, reached on Friday, includes a payment of about $172 million by Cigna. Cigna said it also will enter into a corporate integrity agreement with the U.S. Office of Inspector General.
The class-action lawsuit, filed Monday in federal court in Sacramento, says Cigna Corp. and Cigna Health and Life Insurance Co. rejected more than 300,000 payment claims in just two months last year.
The Cigna Group is an American multinational for-profit managed healthcare and insurance company based in Bloomfield, Connecticut. [2] [3] Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups (e.g., governmental and non-governmental ...
A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization).
Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2]
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