Healthcare Insurance - Payor policies - What is with all the names?

Health insurance across the US has adopted their own languages, not only across the healthcare industry, but within each payor. If your staff is tasked with locating and reading payment policies you know how time-consuming and confusing it can be, not only to find the policies but to understand the contents. 

Does your staff spend time searching for Payor Payment/Coverage Policies?  

Are they baffled by the nomenclature found from payor to payor? 

ZignaAI found this interesting too. Our goal is to provide transparency and clarity to the information used by payors and providers in payment integrity.  

 Here are a few examples: 

  • Coverage Guidelines
  • Medical Policies
  • Medical Benefit Drugs
  • Medical Necessity Guidelines
  • Medical Clinical Policy Bulletin
  • Reimbursement Policies
  • Medical Necessity Decision Policy
  • Coverage Benefit Policies
  • Drug and Biologic Coverage Policy
  • Behavioral Health Coverage Policy
  • Pharmacy Clinical Policy Bulletin
  • Claim Payment Policy Bulletin

ZignaAI has a solution to make finding and comparing policies easier: RevMaxAI Payment Policy Catalog.

The RevMax payment policy catalog was built to find payment policy information quickly, clearly and in one location. Are you tired of jumping from one payment policy site to the next only to end up with little to none of the information you were researching? We were too, so we found a solution and set to work building a catalog of policies. Here, research is faster and much more rewarding.  

Find the policies you need quickly and with confidence. 

Sound interesting? Reach out for a discussion on how we might help your organization.


Add Comment

Zigna’s AI Payor Policy Edit Technology

Most revenue cycle claims editing companies focus on Centers for Medicare and Medicaid (CMS), National Care Determinations (NCD), Local Care Determinations (LCD), and broad national standards. Those are great baselines for medical claim editing, but what moves claims editing from baseline into claims editing with accurate efficiency?

Read More
Impact of price transparency on maternity cost

With a huge rise in the premiums of private health insurance policies and the co-pay, the cost of healthcare including maternity costs is continuously increasing causing a hefty price burden on the American consumers. One major factor that acts as a hindrance in curbing the cost of healthcare is an absence of price transparency.

Read More
Only 9 Percent of US adults are aware that hospitals are required

CMS’s price transparency rule is to make healthcare costs transparent and allow patients to compare prices across hospitals to find facilities that offer the same service at a lower cost. But a recent survey conducted by Kaiser Family Foundation (KFF) identified that most of the adults are unaware of this rule.

Read More
Why is Price Transparency Critical to Reducing Waste in Healthcare

The growth of health care cost-sharing in recent years has led to increased demand for price transparency. Federal government, State legislatures and corporate boardrooms have responded with various programs to make the costs of health care services more accessible.

Read More
Price Transparency - Focus on Payers

Price transparency involves informing, preparing, and involving individuals about treatment costs before receiving them. It essentially improve healthcare standards and encourage individuals to get the right treatments without intentional or unintentional delays. In the United States, health spending was found to have increased by 2.7% in 2021 to $4.3 trillion.

Read More