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 discusses a settlement that will change how private payers reference out-of-network reimbursement benchmarks tied to usual and customary rates. It is relevant to healthcare reimbursement, payer policy, compliance, and provider billing professionals who track payer methodology and state attorney general actions. The article also summarizes the planned transition from a proprietary database to an independent non-profit resource and the consumer-facing information it is expected to provide.
Why This Topic Matters
Changes to payer benchmark databases can affect out-of-network reimbursement practices, patient estimates, and provider payment expectations. Readers in billing, reimbursement, compliance, and payer contracting may need to monitor how the settlement reshapes the information sources insurers use.
What You Will Learn
- The general purpose of the settlement and the reimbursement issue it addresses
- How the article frames the role of a payer-used database in out-of-network payment practices
- What the article says about the planned independent replacement resource
- Why state regulatory action matters for reimbursement methodology and transparency
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance professionals
- Payer contracting teams
- Healthcare administrators
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