Certifi, Inc

HAP CareSource is making a comeback! The health insurance plan will once again offer coverage in Michigan’s Health Insurance Marketplace starting January 1, 2025. HAP CareSource will offer plans in six counties across Michigan, including Shiawassee, Genesee, Lapeer, Oakland, Macomb, and Wayne. The plans will provide access to a wide range of healthcare services, including specialized care. Open enrollment for the Marketplace begins November 1, 2024. Learn more: https://hubs.ly/Q02X7jgs0

UnitedHealthcare is expanding its reach in the Affordable Care Act (ACA) market for 2025. The insurer will now offer plans in 30 states, including four new states: Indiana, Iowa, Nebraska, and Wyoming. The company is increasing its geographic reach to serve more individuals and families and will offer plans with $0 deductibles and predictable copays. Enhanced benefits include coverage for dental, vision, and fitness services. Learn more: https://hubs.ly/Q02X7jz70

The 2025 Medicare Advantage Star Ratings are in, and there are significant trends to note. Insurtechs are excelling, while traditional giants face challenges. The percentage of plans with 4+ stars has decreased for three consecutive years. Plans must meet higher performance standards to achieve higher ratings. Alignment Health and Clover Health are among the top performers while UnitedHealth and Humana experienced significant drops in star ratings. Non-profit plans tend to outperform for-profit plans. Learn more: https://hubs.ly/Q02Vb-4H0

During this year's open enrollment, a new group can participate in the Affordable Care Act (ACA): DACA recipients. A recent rule allows DACA recipients to qualify as "lawfully present" for ACA enrollment. This is estimated to benefit around 100,000 previously uninsured. However, the rule is being contested in federal court by several states. Arguments center on administrative burden and potential immigration policy implications. Learn more: https://hubs.ly/Q02X7jhb0

Cigna Healthcare, a major health insurer, is facing rising healthcare costs, particularly due to the increasing popularity of GLP-1 medications. The company is adjusting its pricing strategies to account for these trends. The company is adjusting its pricing to reflect these increased costs while maintaining competitive offerings. The company is focused on providing tailored solutions to employers, including provider networks and innovative benefit programs. Cigna reported strong third-quarter earnings, driven by growth in its core businesses. Learn more: https://hubs.ly/Q02X7cHZ0

A new study by Elevance Health reveals a significant correlation between the growth of Medicare Advantage (MA) and lower overall Medicare spending. Key Findings: - Reduced Medicare Spending: MA enrollment has contributed to a $431 billion decrease in Medicare spending from 2010 to 2020. - Per-Person Savings: MA enrollees spend an average of $500 less per year compared to traditional Medicare beneficiaries. - Spillover Effect: MA's focus on quality and efficiency may influence the behavior of providers serving both MA and traditional Medicare patients. Learn more: https://hubs.ly/Q02X7jbc0

California is automating its health insurance enrollment system for the first time. This new system, powered by Google Cloud and Deloitte, uses artificial intelligence (AI) to streamline the process for residents. The platform includes: Automated Document Verification: Last year's pilot program saw success with AI verifying 80-96% of documents automatically, significantly reducing processing time from days/weeks to seconds. Scalability for Open Enrollment: The cloud-based system can adjust its capacity to handle the surge in demand during open enrollment periods. Learn more: https://hubs.ly/Q02X7c0q0

Leaders in the healthcare payer industry are setting their sights on innovation in 2025. Here's a glimpse into what excites them most based on a recent Becker's Payer Issues Roundtable discussion. Focus on AI and Technology: - Harnessing the Power of Data: Payers are excited about leveraging AI and machine learning for data analysis. This will enable them to predict health risks, personalize care, and optimize workflows. - Automating Tasks and Freeing Up Professionals: AI can automate tedious tasks like credentialing and customer service interactions, freeing up valuable time for healthcare professionals. Improving Health Equity and Outcomes: - Addressing Social Determinants of Health: Payers are looking at ways to address social needs like housing and food insecurity, which significantly impact health outcomes. - Expanding Access to Mental Health Services: Increased awareness of the need for mental healthcare is driving investment in solutions for teens and employers. - Investing in Primary Care: Partnerships with primary care providers and value-based care arrangements are seen as key to improving population health outcomes. New Care Models and Affordability: - Individual Coverage Health Reimbursement Arrangements (ICHRAs): This employer-sponsored health benefit option empowers employees to choose individual health plans, potentially leading to cost savings. - Value-Based Care: Models that reward providers for better patient outcomes and cost-efficiency are gaining traction. Investing in the Workforce: - Developing a Member-Centric Culture: Building a strong and skilled workforce focused on exceptional member experience is crucial. The Takeaway: Payer executives are optimistic about the future of healthcare, with a focus on leveraging technology, improving health equity, and exploring new care models to deliver better outcomes and affordability for all. Learn more: https://hubs.ly/Q02X1Lxl0

Is your health plan struggling with manual, error-prone premium billing processes? It's time to unlock the potential of premium billing software! By automating repetitive tasks, improving accuracy, and offering enhanced payment options, premium billing software can significantly boost your health plan's efficiency and profitability. Discover how software can: - Save valuable time and resources - Increase revenue through accurate remittances and reduced write-offs - Improve member satisfaction and retention - Provide valuable insights for data-driven decision-making Learn more: https://hubs.ly/Q02LPf2v0

The pet insurance industry is experiencing rapid growth, and insurers are looking for efficient ways to manage their billing processes. As the volume of policies increases, manual processes become less feasible. Here are some key factors to consider when selecting pet insurance group billing software: - Robust Reporting Capabilities: Detailed reports on aging receivables, delinquencies, invoices, and payments are essential for effective financial management. - Flexible Invoicing: Customizable invoices that can be tailored to specific client needs. - Efficient Retroactivity and Credit Management: Automated processes for handling retroactive adjustments and credit balances. - Pro-Ration Options: Support for various pro-ration methods to ensure accurate billing for mid-month changes. - Cost-Effective Solutions: Cloud-based solutions can help reduce costs and improve efficiency. Learn more: https://hubs.ly/Q02Yxv3r0