decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 2 (February)
UHC Agrees to Close Ingenix ‘Usual and Customary’ Databases
Subscribe or sign in to view the full article.
Article Overview
This article explains a settlement that affects how private insurers determine usual and customary reimbursement amounts for out-of-network services. It discusses the role of an Ingenix database, the planned creation of a new independent nonprofit database, and the broader payer and consumer implications of the change. The content is relevant to professionals tracking health plan reimbursement practices, payer policy, and regulatory oversight.
Why This Topic Matters
Changes to how usual and customary rates are determined can affect out-of-network reimbursement, patient cost exposure, and insurer payment practices. The article is relevant for understanding a notable regulatory settlement and its potential impact on reimbursement transparency.
What You Will Learn
- How a settlement is expected to affect out-of-network reimbursement methods
- Why usual and customary rate determination drew regulatory scrutiny
- What changes were announced for the database used by insurers
- How the new database is intended to support consumers and insurers
Who Should Read This
- Medical coders
- Billing professionals
- Revenue cycle staff
- Health plan administrators
- Compliance professionals
- Healthcare attorneys
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com