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Technology Posts

Challenges with Integrating Multiple Claims Software Systems on a Single Technology Platform

By Michelle Spencer
For most payers, having more than one claims software system is a fact of life. At least if they’re offering dental. Because while most of the benefits they offer – medical, vision, physical therapy, long-term care, etc. – can run on their core systems since they share coding and other characteristics, as a general rule dental claims cannot.

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Benefit Management Technology Taking an Autonomous Car Approach

By Doug Wilkens
You would pretty much have to spend the last couple of years alone on a tropical island to not be aware of the impending revolution being brought on by the so-called “autonomous car.” In the next few years, major automakers and tech giants such as Google and Microsoft are saying they will be putting cars on the road that completely automate the process of getting from here to there. No drivers needed – just tell the car where you want to go and it will take you there. It promises to be a game-changer. Similar innovations are now coming to benefit management.

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Disruptive Benefit Management Software

By Mike Lessila
I think we can all agree that most people don't like change. Change is hard. It gets us out of our comfort zones. It introduces uncertainty and risk. Yet it's often necessary, especially in business. Solutions designed for the marketplace of 30 years ago don't always translate to the realities of today.

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Advice for Health Plans on Leveraging Software as a Service

By Michael Gardipee
Watch this video blog to determine if Software as a Service, or SaaS, is the right choice for your organization.

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6 Tips for Ensuring Dashboards Drive Operational Efficiency

By Michelle Spencer
Ever since the advent of the big data era a dozen or so years ago, one of the most popular business concepts has been the dashboard. The phrase “We need an executive dashboard” has echoed down the hallways and through the boardrooms of corporate America, sending operational and IT teams into a frenzy to deliver these colorful renderings of the state of the organization.

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Making reimbursement as simple and speedy as getting a flu shot

By Greg Borca
A couple of weeks ago I decided it was time for my annual flu shot. I ran out to my local pharmacy, told them what I wanted and in about 15 minutes I was (hopefully) protected against whatever nasty strains are making the rounds this year. The entire process was a marvel of efficiency. Especially when it came time to pay. The pharmacy already had my health insurance information in their system, so when they rang the transaction the insurance claim was already adjudicated and paid, and my portion determined. I knew exactly what it would cost me, and I paid it before the shot was administered.

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Time for dental provider credentialing to join the 21st century

By Mike Lessila
For most dentists, the provider credentialing process must feel like the movie Groundhog Day. The office receives a form that must be filled out in order to add the provider to the payer’s dental network. The dentist or a staff member then dutifully fills out the form and mails it back or (in the more “progressive” instances) submits it online. Next week, another form comes in asking for the same information and the office goes through the process again. Rinse and repeat for each payer’s dental network.

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Technology Helps Payers Transition for the Future

By Craig Kasten
Despite all the advances in technology over the last three decades, many large health payers are still conducting aspects of their business the way they did in the pre-Internet days of the 1980s, relying on manual processes and interactions with members and providers.

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Five Principles to Leveraging Benefit Administration Technology to Succeed During Reform

By Mike Lessila
Well, no one said healthcare reform via the Affordable Care Act (ACA) would be easy. In fact, it's proven to be quite painful at times as healthcare payers scramble to realign their organizations to accommodate an entirely different way of working without disrupting their current business.

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Benefit Management Posts

How client experience teams help health plans succeed

By Teresa Velk
Payers who are responsible for delivering government-sponsored healthcare face several significant challenges in their mission to be the best possible stewards of the programs they administer. This includes programs such as Medicaid where payers are tasked with stretching limited dollars to provide the most access, to the most appropriate and efficient care, for the most members.

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How Daily Payments Can Help You Build your Medicaid Dental Provider Network

By Gail Buenger
Attracting dentists to a Medicaid dental provider network isn’t easy. Typically these programs pay only a fraction of what commercial plans offer. As a result, dentists tend to join because they feel a moral, altruistic calling to serve the most vulnerable population and have a desire to expand their patient rosters.

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Using Online Benefit Management Portals for Dental Offices

By Matt Martin
Web portals create greater efficiency and faster turnaround times. That translates to less time spent on administrative tasks. Learn more by watching this video blog.

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Things Medicaid Dental Members Should Know Before Visiting the Dentist

By Mike Kilduff, Jeanine Saer, & Tina Johann
Dental wellness is an important contributor to your overall health and wellbeing. It can have an effect on your ability to eat the foods you want, speak clearly, and even sleep at night. It can also have an effect on your self-esteem, the way you interact with others socially, and your ability to enjoy life to the fullest.

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Insurance software that improves the provider experience gives payers a competitive advantage

By Patrick Ruesch
Much has been written in the last few years about how payers need to use insurance software to improve the customer experience in order to attract and retain members. Especially with the addition of millions of individual member policies as a result of the Affordable Care Act (ACA). Not to mention the increased importance of patient satisfaction scores. Yet there is another group that is just as important to payer success whose user experience needs to be considered carefully as well – the provider network.

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Become a high-performing Medicaid Dental program by keeping your focus on lower benefit costs

By John Schaak
Whenever the talk turns to cutting Medicaid dental costs, the focus is often on reducing administrative fees. Yet while it is important to keep administrative fees low, they represent only about 5% of any program’s total cost. The biggest opportunity to bend the cost curve lies in the other 95%, i.e., the actual benefit costs. This is where the highest-performing Medicaid dental programs are focused—saving a few dollars, instead of a few pennies, per member per month.

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Addressing the Impact of Medicaid Dental Insurance Fraud

By Lisa Sweeney
Despite greater awareness and law enforcement’s efforts to crack down, Medicaid dental insurance fraud continues to be big business. A simple Google search on that term will confirm this unfortunate fact, serving up article after article about dentists being prosecuted for fraud, waste and abuse (FWA), often on children in the Medicaid dental program.

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Rolling the dice on adding Medicare dental to your Medicare Advantage plan

By Mark Borca
For Medicare Advantage (MA) managed care plans, the decision on whether to add Medicare dental coverage is a roll of the dice. On the plus side, if adding dental helps the plan pull members away from other managed care organizations (MCOs) and increase market share, it can be a huge win.

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Offline and Falling Behind

By Matt Martin
I doubt that when many dentists first dreamed of going to dental school that checking patient eligibility, submitting insurance claims or chasing down payments is what they pictured. Given how time-consuming and painful those tasks can be, you’d think they would leap to sign up for free online portals that do the job faster and more efficiently. But in many cases you’d be wrong.

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A look at trends that will affect payers in 2016 - and beyond

By Greg Borca
With an election year upon us once again it seems like everyone is even more interested in the future than usual. That’s what caught my eye about an insightful article in Managed Healthcare Executive from a couple of thought leaders at GE Healthcare Camden Group.

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SKYGEN USA

W140 N8981 Lilly Rd.
Menomonee Falls, WI 53051
info@skygenusa.com

  • SKYGEN USA
  • Wonderbox Technologies
  • Scion Dental
  • Vestica Healthcare
  • Ocular Benefits
  • American Therapy Administrators
  • Hylis Pharmacy Solutions
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