decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 3 (March)
UHC agrees to close Ingenix ‘usual and customary’ database
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Article Overview
This article covers a settlement involving UnitedHealthCare, Ingenix, and the New York Attorney General’s office that affects private payer methods for determining out-of-network reimbursement benchmarks. It explains the broader policy and compliance implications for insurers, providers, and consumers, including the transition to a new independent database and the role of public oversight.
Why This Topic Matters
The topic is important because usual-and-customary reimbursement methodology can affect payment levels for out-of-network claims and has implications for payer transparency, data independence, and industry practices.
What You Will Learn
- How a settlement changed the landscape for private payer usual-and-customary reimbursement references.
- Why insurer-controlled reimbursement databases raised conflict-of-interest concerns.
- What general steps were announced for replacing the existing database with an independent resource.
- How consumer-facing reimbursement information may be made more accessible.
Who Should Read This
- Medical coders
- Billing and reimbursement professionals
- Practice managers
- Healthcare compliance staff
- Insurers and payer operations teams
- Healthcare policy readers
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