
“With over 1,000 health insurance carriers offering 318,000 distinct health plan products in the U.S. market………..Each carrier develops its own contract terms such as payment schedules, documentation standards, and prior authorization processes. They can market multiple types of products, HMOs, PPOs, high-deductible health plans, and each plan can have their own set of in-network providers. The complexity of this process contributes to the high billing-related costs in the U.S. market.“
Continue reading Developing a Computable Payer-Provider Contract
