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The first HMOs in the U.S., such as Kaiser Permanente in Oakland, California, and the Health Insurance Plan (HIP) in New York, were "staff-model" HMOs, which owned their own health care facilities and employed the doctors and other health care professionals who staffed them. The name health maintenance organization stems from the idea that the ...
As insurance premiums have surged, families with employer-sponsored health care plans have paid nearly 5% of their total earnings over a 32-year period, according to a 2024 report investigating ...
TriWest Healthcare Alliance is a Phoenix, Arizona based corporation that manages health benefits under the United States Department of Veterans Affairs (VA) VAPCCC program in Regions 3, 5, and 6. [1] On October 1, 2018, TriWest's contract for VAPCCC was expanded to cover Regions 1, 2, and 4.
In order to be clear on the payment of a medical billing claim, the health care provider or medical biller must have complete knowledge of different insurance plans that insurance companies are offering, and the laws and regulations that preside over them. Large insurance companies can have up to 15 different plans contracted with one provider.
A Health Reimbursement Arrangement, also known as a Health Reimbursement Account (HRA), [1] is a type of US employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses and, in limited cases, to pay for health insurance plan premiums.
The Federally Facilitated Marketplace (FFM) is an organized marketplace for health insurance plans operated by the U.S. Department of Health and Human Services (HHS). The FFM opened for enrollments starting October 1, 2013. [1]
The EDI Health Care Claim Payment/Advice Transaction Set (835) can be used to make a payment, send an Explanation of Benefits (EOB), send an Explanation of Payments (EOP) remittance advice, or make a payment and send an EOP remittance advice only from a health insurer to a health care provider either directly or via a financial institution.
In the Washington, D.C. metropolitan area, plans open to all federal employees and annuitants include 10 fee-for-service and PPO plans, seven HMOs, and eight high-deductible and consumer-driven plans. [4] In the FEHB program the federal government sets minimal standards that, if met by an insurance company, allows it to participate in the program.