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Concerns have also been raised about insurance carriers' efforts to limit the number of providers in their networks to reduce costs. A study of the California marketplace confirmed these concerns, but also showed that geographic access was similar and quality at times superior in marketplace-based plans. [99] "Cherry-picking"
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
Superior HealthPlan is a joint-venture of Centene and Community Health Centers Network LP, which provides services for Medicaid recipients. [33] The article reported that Superior HealthPlan had previously paid healthcare claims for the infant at the hospital, although Superior HealthPlan stated that it did not cover procedures at the facility ...
Amerigroup is an American health insurance and managed health care provider. Amerigroup covers 7.7 million seniors, people with disabilities, low-income families and other state and federally sponsored beneficiaries, and federal employees in 26 states, making it the nation's largest provider of health care for public programs. [1]
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 ...
Healthgrades evaluates hospitals solely on risk-adjusted mortality and in-hospital complications. [17] Its website evaluates roughly 500 million claims from federal and private reviews and data to rate and rank doctors based on complication rates at the hospitals where they practice, experience, and patient satisfaction. [8]
The Council for Affordable Quality Healthcare, Inc. (CAQH) is a non-profit organization [4] incorporated in California as a mutual benefit corporation. It was first incorporated under the name Coalition for Affordable, Quality Healthcare, Inc., and then renamed the Council for Affordable Quality Healthcare, Inc. on August 8, 2002.
CalWIN is an online, real-time computer program that supports the administration of welfare in California.These include CalWORKs (TANF), CalFresh (food stamps), Medi-Cal (Medicaid), General Assistance/General Relief, Foster Care, and case management functions for employment services.