Even just a handful of high-cost, catastrophic claims can put significant pressure on health plan payers and the members that they cover. And, while many strategies exist to manage these claim costs as they arise, most of them take a reactive approach, intervening only after the claim is submitted and the dollars start moving. A more effective approach lies in a proactive, full-cycle strategy — one that identifies and prevents unnecessary spending both before and after payment is issued. Below, learn how Vālenz Health® is putting that strategy into action with industry-leading payment integrity solutions that act across the entire length of the Claim Cost Arc, uncovering savings at every step of the process. The results: A significant reduction in costs, an optimized claims experience, and smarter, better, faster #healthcare for all involved. #paymentintegrity #engageearlyandoften #highvaluehealthcare #accountability #innovation
How Vālenz Health reduces healthcare costs with proactive strategy
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REDUCING CLAIM QUERIES – PART 4 Expiry Dates In busy healthcare settings, where patient volumes are high, it is understandable that claims may not always be processed in real time. However, when a claim is put aside for later processing, there is a risk that by the time it is entered, the card or policy may have expired. Health service providers, please make it a point to always check the expiry date on health cards. Sometimes, a policy might be just a few days from expiry; taking note of this helps you plan appropriately and prevent situations where a claim cannot be processed due to an expired policy. A small step like taking note of dates can go a long way in reducing claim queries and ensuring smoother processing. #HealthInsurance #ReducingClaimQueries #ClaimsManagement #HealthServiceProviders
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As health care policy continues to shift, payers, providers, and government agencies need trusted actuarial support. From ACA-related filings to cost-sharing and benchmark analysis, L&E helps you stay ahead. https://bit.ly/4jIPY3n #HealthcarePolicy #HealthcareReform #ActuarialSupport #ACAcompliance
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🚨 Health Insurers Face Rising Medical Costs: Q3 2025 Medical Loss Ratios Climb Higher New quarterly data from health insurers reveals a clear trend—utilization is driving up medical cost/care ratios across the board. Rising utilization = higher claims = pressure on margins. Are we seeing the post-pandemic care backlog finally hit full force? What’s your take—sustainable trend or temporary surge? 👇 #HealthInsurance # #HealthcareCosts #UtilizationTrends #Collaboration
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"The amount health insurers charge for coverage on the ACA Marketplaces is rising 26%, on average, in 2026. In states that run their own Marketplaces, the average benchmark (second-lowest cost) silver premium, on which the tax credit calculation is based, is rising 17% next year. In states that use Healthcare.gov, these premiums are rising an average of 30%." Read more: https://lnkd.in/eKD29MaZ
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Group health plan sponsors: Medicare Part D notices are due before Oct. 15, 2025. Our bulletin covers the steps employers should take to avoid higher premiums for the employees and key information on creditable coverage, model notices, timing of notices, and delivery methodology. Learn more here. https://ow.ly/KkBH50XkQnf
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💡 ZINNsight: 84% of employees are covered by health plans with three or more drug tiers. Understanding how your plan’s formulary and tier system work can make a huge difference in what you pay—and what you save. Learn more in our latest post: https://lnkd.in/giWHMcaE #ZINNsights #InsuranceEducation #EmployeeBenefits #PharmacyCoverage #ZinnInsurance
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Access. Coverage. Affordability. JLL's 2025 Patient Consumer Survey reveals how these three pillars are driving patient decisions. 🔍 Key findings: Insurance coverage, affordability barriers, and unequal access are creating significant care gaps. 67% of uninsured patients skipped in-person care last year 16% avoided care due to rising costs Rural patients are traveling over 30 minutes for essential services. 💡 What does this mean for healthcare providers? Real estate strategy must prioritize patient reach, equity and experience, as location decisions directly impact access to care. Let's reimagine healthcare delivery with strategic site selection, coverage-conscious planning and affordability-first models: https://bit.ly/4ph2KYY #OneJLL
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As major Medicare Advantage insurers pull back from traditional plan offerings, they’re finding new growth in Special Needs Plans (SNPs), a segment designed to meet the needs of complex and vulnerable member populations. But with that opportunity comes heightened regulatory scrutiny and operational challenges. SNPs require precise compliance management, member-level data accuracy, and continuous monitoring to meet CMS standards. That’s where Inovaare helps health plans lead with confidence, delivering cloud-based compliance solutions that simplify oversight, reduce risk, and drive better outcomes for members. Read full story: https://lnkd.in/g4ubkihU #MedicareAdvantage #SNP #HealthcareCompliance
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🔍 Denials are expensive—catch errors before claims go out the door. NYX Health®’s Pre-Bill Claim Review identifies coding and documentation issues early, ensuring compliance and maximizing reimbursement. 💡 A proactive approach that protects your bottom line. Learn how: https://lnkd.in/gmVS4ssm
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Learn more about our industry-leading approach here: https://blog.valenzhealth.com/high-cost-claims-management