For more than a decade, experts and pioneering states have built the case for the state level All Payer Claims Database (APCD). Eighteen states have implemented APCD solutions, proving value, and providing lessons learned. And now, the ‘surprise’ catalyst that is expected to light the fire for those states not yet legislated for APCD, the No Surprises Act.
COVID-19 will impact risk score factors for MA plans in 2021 and cause them to get paid less for their enrollees than projected. There could be an industry wide impact on overall profitability unless plans capitalize on powerful Risk Adjustment tools. Solutions, such as Babel Health’s integrated RA tool, will play a significant role in helping plans maximize what does make it to/through their claim processing.