Everyone will agree that emergency care is a necessary and important part of the US healthcare system. Timely access to emergency care is undisputed. The role of the ER is undermined, however, when used for non-emergent care that can be safely rendered elsewhere. A recent report by Accenture examined one
The expanding cost and responsibilities associated with employer-sponsored healthcare Businesses across the board, from automakers to tech companies to taxpayer-funded school systems, spend a large portion of their budgets on employees in the form of salary and benefits. A rapidly growing percentage of these costs go to fund employee healthcare
PLANO, TX – SmartLight Analytics opens its new Plano, Texas, headquarters this week beginning a new chapter for the growing team of data and clinical experts working to help self-funded employers to reduce healthcare spending by identifying and eliminating fraud, waste, and abuse in healthcare claims. The new office
Eliminating out-of-network (OON) benefits in self-funded employee healthcare plans tackles several problems for employers and benefits administrators: healthcare plan costs, dealing with laborious ERISA out-of-network appeals and the potential for fraud. Employers and their insurance companies negotiate contracts with in-network healthcare providers and facilities such as hospitals and rehabilitation centers.
The continued use of telemedicine – made dramatically more mainstream during the pandemic – may open the door for more fraud, waste, and abuse in healthcare claims. The number of fraud cases related to healthcare “more than doubled from 2019 to 2020 and was at the highest level ever reported”
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SmartLight Analytics combines the best inferential analytic models with a team of analytic and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data. Learn More >