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 explains a settlement between the New York Attorney General’s office and UnitedHealthcare that affects the private insurance process for setting usual and customary payment rates for out-of-network services. It is relevant to health plans, billing and reimbursement stakeholders, and coding/revenue cycle professionals who follow payer policy changes and data sources used in out-of-network payment determinations. The article also discusses the planned replacement database, timing, and the general concerns that prompted the investigation.
Why This Topic Matters
Payer databases and reimbursement methodology can influence out-of-network payment levels, claim outcomes, and patient cost exposure. This settlement may affect how insurers reference market-rate data and how providers interpret reimbursement information.
What You Will Learn
- Why the Ingenix database became the subject of a settlement
- How the article characterizes the role of usual and customary reimbursement data
- What changes were announced for the insurer database and related consumer access
- What organizations and public officials are involved in the settlement and follow-up efforts
Who Should Read This
- Medical coders
- Revenue cycle professionals
- Billing staff
- Practice managers
- Healthcare compliance professionals
- Payer policy analysts
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