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 involving UnitedHealthCare and the New York Attorney General’s office that affects how private payers determine usual and customary payment rates for out-of-network services. It is relevant to health plans, providers, and billing professionals who follow reimbursement methodology, insurer transparency, and changes to claims payment practices. The piece also discusses the planned replacement of an existing database with a new independent resource and the broader concerns that prompted the investigation.
Why This Topic Matters
The settlement may affect out-of-network reimbursement processes, payer data sources, and transparency for patients and providers. Readers who deal with claims payment policy or reimbursement methodology may want to understand the operational impact and timing of the transition.
What You Will Learn
- Why usual and customary out-of-network reimbursement practices are being changed
- How the settlement is expected to affect insurer data sources
- What role a new independent database is intended to play
- Why transparency in out-of-network reimbursement matters to consumers and providers
Who Should Read This
- Medical billing professionals
- Coders and coding managers
- Revenue cycle staff
- Practice administrators
- Health plan and payer policy readers
- Healthcare compliance professionals
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