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The company has received praise for its innovative alternative quality contract (AQC) payment model. [10] [11] In 2007, then-CEO Cleve Killingsworth set a six-month deadline for the company to come up with a new payment plan to offer health care providers. [12]
EOHHS is the largest secretariat in Massachusetts, and is responsible for the Medicaid program, child welfare, public health, disabilities, veterans’ affairs, and elder affairs. In total, EOHHS oversees 11 state agencies and the MassHealth Program. [1]
The law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage, provided free and subsidized health care insurance for residents earning less than 150% and 300%, respectively, of the federal poverty level (FPL) [2] and mandated employers with more than 10 full-time employees provide healthcare insurance.
As of May 2019, the organization had over 1 million members. The Tufts Health Plan network includes 110 hospitals and 51,000+ health care providers. The health plan offers products for employers, individuals enrolled in Medicare, Medicaid the Massachusetts Health Insurance Exchange, and individuals who are dually eligible for Medicare and ...
GuideWell, formally GuideWell Mutual Holding Corporation (holding company for Florida Blue), is a mutual insurance holding company primarily focused on health insurance in Florida. It was created in 2013 by a reorganization initiated by Florida Blue, a member company of the Blue Cross Blue Shield Association . [ 4 ]
Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
The same memorandum said that 212,800 claims had been refused payment due to pre-existing conditions and that insurance firms had business plans to limit money paid based on these pre-existing conditions. These persons who might not have received insurance under previous industry practices are guaranteed insurance coverage under the ACA.
Harvard Pilgrim Health Care is a non-profit health services company based in Canton, Massachusetts serving the New England region of the United States.. On August 14, 2019, the boards of Harvard Pilgrim Health Care and Tufts Health Plan announced plans for the two insurers to merge their organizations into a new company.