A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't ...

A federal lawsuit has focused attention on how the industry uses medical codes for risk adjustment. While the lawsuit doesn’t involve physician practices, it’s a heads-up for them to pay attention to ...

NEW YORK CITY, NY / ACCESS Newswire / June 1, 2025 / As healthcare payers face intensified regulatory oversight, rising healthcare costs, and the evolving complexities of risk adjustment, Black Book ...

Healthcare risk management solutions company Talix has launched Coding InSight for Payers. Coding InSight for Payers is designed to help health plans automate and streamline risk adjustment processes ...

Talix has entered into a reseller agreement with NextGen Healthcare, Allscripts and Capstone Performance Systems to make Talix’s risk-adjusted coding solution available to customers on the companies’ ...

Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health ...

George Witwer, CEO of Cavo Health Outperforms Machine Learning Tools with 96%+ HCC completeness, 2–4x Productivity Gains and Reduced Audit Risk Our platform delivers more accurate, audit-ready results ...

The Alliance of Community Health Plans is calling out risk adjustment scores by larger insurers in Medicare Advantage plans. ACHP, an organization that advocates for smaller health plans, said the ...