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Massachusetts hospitals rate health plan performance

Massachusetts hospitals rate health plan performance
October 06, 2008

A new report from the Massachusetts Hospital Association compares the state’s health plans on the cost, effectiveness and efficiency of their administrative practices. Based on a survey of hospital executives, the report rates the performance of 12 health plans in areas such as claims payment, member education, authorization processes and utilization management. Among other recommendations, it concludes that the plans could improve their radiology management programs and claims adjudication, regularly update and disseminate evidence-based clinical guidelines, give providers more opportunity to review and verify the information used in their “tiering” programs, and better educate plan members about their benefits and obligations. MHA President and CEO Lynn Nicholas said the report " highlights a less publicized opportunity to curb costs by continuing to streamline and simplify many of the administrative processes built into health plans' relationships with health care providers.”